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EMPLOYMENT APPLICATION 1. Employer: Flowers by Don & The Stuffed Basket Address: 2715 Manatee Avenue West City/State/Zip: Bradenton, Florida 34205 Telephone: (941)748-6810 Fax (941) 748-2459 It is the policy of Flowers by Don & The Stuffed Basket to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status. 2. Applicant Name: ___________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Number of years at this address: _________ Daytime phone: ____________________ Evening phone: ____________________ Social Security Number: ___________________________ 3. Who should be contacted if you are involved in an emergency? Contact Name: ___________________________________________ Relationship to you: ___________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Daytime phone: ____________________ Evening phone: ____________________
4. Job Position Applied For: Designer 5. Referral Source: Who referred you to our company? ___________________________________________________________ 6. Have you applied to our company previously? ______ Yes ______ No If yes, when? ________________________ 7. Are you at least 18 years old? ______ Yes ______ No 8. How will you get to work? _____________________________________ 9. Driver's License Number: ___________________________ What state issued your license? ______________________ 10. If you are offered employment, when would you be available to begin work? ____________________________________ 11. Are you legally eligible for employment in the United States? ______ Yes ______ No
12. Are you able to perform the essential functions of the job position with or without reasonable accommodation? ______ Yes ______ No What reasonable accommodation, if any, would you require? ________________________________________________ 13. Applicant Employment History: List your current or most recent employment first. Employer Name: ___________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Job Duties: ___________________________________________ Reason for Leaving: ___________________________________________ Dates of Employment (Month/Year): _____________________________
Employer Name: ___________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Job Duties: ___________________________________________ Reason for Leaving: ___________________________________________ Dates of Employment (Month/Year): _____________________________
Employer Name: ___________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Job Duties: ___________________________________________ Reason for Leaving: ___________________________________________ Dates of Employment (Month/Year): _____________________________ 14. Applicant's Education and Training: List your education and training. High School Name and Address ____________________________________________________________ Last Grade? ____ 9 ____ 10 ____ 11 ____ 12 Diploma? ______ Yes ______ No College Name and Address ____________________________________________________________ Did you receive a degree? ______ Yes _____ No If yes, degree received: ___________ Other Training (graduate, technical, vocational): ____________________________________________________________ Awards, Honors, Special Achievements: ____________________________________________________________
15. Applicant's Skills: Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.) Ability or Skill Years of Experience Rating [ ] Floral Design-Fresh Flowers __________________ 1 2 3 4 5 [ ] Gift and Food Baskets __________________ 1 2 3 4 5 [ ] Multi-Line Phone System __________________ 1 2 3 4 5 [ ] Customer Service __________________ 1 2 3 4 5 ____________________________ __________________ 1 2 3 4 5 16. References: List any two people who would be willing to provide a reference for you. Name: ___________________________________ Address: ___________________________________ City/State/Zip: ___________________________________ Telephone: _______________________ Relationship: _______________________
Name: ___________________________________ Address: ___________________________________ City/State/Zip: ___________________________________ Telephone: _______________________ Relationship: _______________________
17. Please provide any other information that you believe should be considered: ____________________________________________________________ ____________________________________________________________
CERTIFICATION I certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences, immediate termination. I authorize Flowers by Don & The Stuffed Basket to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Manager, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of Flowers by Don & The Stuffed Basket, except in a specific written contract of employment signed on behalf of the organization by its Manager, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
____________________________________ _______________ APPLICANT SIGNATURE DATE Copyright © 1999 - 2006 Tipton Enterprises Inc. All rights reserved. Site Updated 19-Apr-2006 By Brian Sellers |