Greenbrier Nurseries
APPLICATION FOR EMPLOYMENT
NAME_________________________________________________________________

___-___-___ ___-______-___-___-___

First Middle Last Social Security Number
 
Mailing Address
Street _________________________________________
City ______________________ State ______ Zip Code_____________
TELEPHONE
  • (Area code) Home Number (______) ________-___________
  • (Area Code) Business Number (______) _______-____________
TYPE OF EMPLOYMENT YOU WILL ACCEPT: YES NO    

A ____ Permanent Full-Time

 ____ ____ Have you applied with Greenbrier Nurseries in the past 12 months?

B ____ Permanent Part-Time

 ____ ____ Can you legally work permanently/temporarily in the United States?
      If temporarily, provide expiration date: ____________________

C ____ Temporary Full-Time

 ____ ____ Have you ever been arrested or convicted of a felony or misdemeanor?
      If so, explain_________________________________

D ____ Temporary Part-Time

 ____ ____ ________________________________________________

E ____ Seasonal

____ ____   _________________________________________________
DATE YOU ARE AVAILABLE TO INTERVIEW: ______________________________________________________________________
DATE AVAILABLE TO START WORK: _____________________________________________________________________________
DO YOU HAVE A RELIABLE MEANS OF TRANSPORTATION TO GET TO WORK?____________ Driver’s License #_______________
EMPLOYMENT HISTORY:  
LIST ALL WORK EXPERIENCE BEGINNING WITH YOUR PRESENT OR MOST RECENT JOB AND WORK BACK.
1.
Employer Name & Address Employer Phone No.
Type of Business Name of Supervisor Your Job Title Last Salary
Employment Dates

From: ____________________ to____________________

month/year month/year

 Employment Status:

___Full time ___Part-tme Number of hours per week: _______
Did You Supervise Any Employees?

___Yes ___No

 Date You Began Supervising List Titles & Number of Employees You Supervised.
Detailed Description of Duties and Responsibilities:

2

Employer Name & Address Employer Phone No.
Type of Business Name of Supervisor Your Job Title Last Salary
Employment Dates

From: ____________________ to____________________

month/year month/year

 Employment Status:

___Full time ___Part-tme Number of hours per week:_____
Did You Supervise Any Employees?

___Yes ___No

 Date You Began Supervising List Titles & Number of Employees You Supervised.
Detailed Description of Duties and Responsibilities:

EMPLOYMENT HISTORY CONTINUED:

3

Employer Name & Address Employer Phone No.
Type of Business Name of Supervisor Your Job Title Last Salary
Employment Dates

From:

____________________ to____________________

month/year month/year

 Employment Status:

___Full time ___Part-tme Number of hours per week:_______
Did You Supervise Any Employees?

___Yes ___No

 Date You Began Supervising List Titles & Number of Employees You Supervised.
Detailed Description of Duties and Responsibilities:
EDUCATION:        
HIGH SCHOOL ADDRESS CITY,STATE DATES OF ATTENDANCE DIPLOMA
1.__________________ __________________ ___________________ ________________________ _________
COLLEGE FIELD(S) OF STUDY CREDIT HOURS DATES OF ATTENDANCE DEGREE
1.__________________ __________________ _______________ ________________________ _________
2.__________________ __________________ _______________ ________________________ _________
TECHNICAL OR OTHER SKILLS THAT YOU HAVE WHICH NEED TO BE CONSIDERED WHEN DETERMINING ELIGIBILITY.
__________________________________________________________________________________
________________________________________________________________________________________
LICENSES/CERTIFICATES/CERTIFICATIONS HELD: _______________________________________________________________________
______________________________________________________________________________________________________________________
PERSONAL REFERENCES: Do not include previous employers.    
NAME & OCCUPATION ADDRESS PHONE
1.________________________________________ ___________________________________________ _______________________
2.________________________________________ ___________________________________________ _______________________
3.________________________________________ ___________________________________________ _______________________
The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history, previous employment, financial and credit record through any investigative or credit agencies or bureaus of your choice.
In making this application for employment I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigative report that is made.
________________________________________________________________   _______________________
Signature of Applicant       Date