Employment – Fiddleheads Garden Center

Employment Application

Name *

First

Last

Why are you seeking employment at Fiddleheads? *

Date of Birth *

Address

Phone *

Email *

SSN

Date Available to Start *

Which position are you applying for?

Are you a US Citizen? *

Yes
No

If not a US citizen, are you authorized to work in the US?

Yes
No

Have you ever worked for this company? *

Yes
No

Have you ever been convicted of a felony? *

Yes
No

Did you graduate High School? Where and when did you graduate? *

Did you graduate College? Where and when did you graduate? What was your degree? *

Other form of education? *

Reference 1 *

First

Last

Reference 1 Phone *

Reference 1 Address

Reference 1 Relationship to you *

Reference 1 Company *

Reference 2 *

First

Last

Reference 2 Phone *

Reference 2 Address

Reference 2 Relationship to you *

Reference 2 Company *

Reference 3 *

First

Last

Reference 3 Phone *

Reference 3 Address

Reference 3 Relationship to you *

Reference 3 Company *

Military Service - Branch

Military Service - Dates served

Rank at Discharge

Type of Discharge

If other than honorable, explain:

Personal Information - Allergies

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Any other medical information which should be known

Previous Employer 1 *

Company Name, Phone, Address, Supervisor, Job Title, Starting Salary, Ending Salary, Responsibilities, Starting Date, Ending Date, Reason for Leaving

May we contact this employer?

Yes
No

Previous Employer 1

Previous Employer 2 *

Company Name, Phone, Address, Supervisor, Job Title, Starting Salary, Ending Salary, Responsibilities, Starting Date, Ending Date, Reason for Leaving

May we contact this employer?

Yes
No

Previous Employer 2

Previous Employer 3 *

Company Name, Phone, Address, Supervisor, Job Title, Starting Salary, Ending Salary, Responsibilities, Starting Date, Ending Date, Reason for Leaving

May we contact this employer?

Yes
No

Previous Employer 3

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