PERSONAL INFORMATION Full Name Email Home Phone# Cell Phone# Present Address Permanent Address Are you over the age of 18 YesNo If not, what is your date of birth EMPLOYMENT DESIRED Position Desired Date of Application Employment you are seeking Full-timePart-timeSeasonal Specify days and hours available (add further details in notes below if needed) Sunday Monday Tuesday Wednesday Thursday Friday Saturday Are you employed now? YesNo If so, may we inquire of your present employer? YesNo Date you can begin work Salary desired Have you ever been employed by Nelson Nursery? YesNo If yes, dates employed Are you available to work weekends as may be required? YesNo I was referred to Nelson Nursery, Inc. by Are you acquainted with anyone that works at Nelson Nursery? EMPLOYMENT HISTORY: List most recent employer first Employer (company name) Immediate supervisor name Job title Street address Employment date (mo. & yr.) Salary City, State, Zip Phone Reason for leaving Summarize your job duties Is there any reason why you would not want us to contact this employer? Employer (company name) Immediate supervisor name Job title Street address Employment date (mo. & yr.) Salary City, State, Zip Phone Reason for leaving Summarize your job duties Is there any reason why you would not want us to contact this employer? Employer (company name) Immediate supervisor name Job title Street address Employment date (mo. & yr.) Salary City, State, Zip Phone Reason for leaving Summarize your job duties Is there any reason why you would not want us to contact this employer? EDUCATION High School & Location Years Completed Graduate YesNo Degree, diploma, cert., area of study Tech School & Location Years Completed Graduate YesNo Degree, diploma, cert., area of study College/University & Location Years Completed Graduate YesNo Degree, diploma, cert., area of study College/Grad School & Location Years Completed Graduate YesNo Degree, diploma, cert., area of study List any job-related seminars, short courses, workshops, or other educational experience WORK EXPERIENCE For cashier/store applicants: What retail experience do you have? For sales applicants: What type of merchandise have you sold? For greenhouse staff applicants: What experience do you have related to annuals, perennials, herbs, or vegetables? For nursery staff applicants: What experience do you have with trees and shrubs? For stock/loading/field staff applicants: What equipment have you used? List any special training or skills -relevant to the position for which you are applying. ( e.g. machine operation, floral design, landscape design, horticulture, foreign language fluency, certification, etc.) REFERENCES Name Phone# Business Years Acquainted Name Phone# Business Years Acquainted Name Phone# Business Years Acquainted ACKNOWLEDGEMENT: PLEASE READ & SIGN By my signature below, I promise that the information provided in this employment application ( and in any related documentation or interview) is true and complete, and I understand that any false or misleading information or significant omissions may disqualify me from further consideration from employment, and may lead to my dismissal from employment, if discovered at a later date. I authorize any person, school, current or prior employer named in this from (or related documents or interview) to provide such persons, employers, and schools from any liability in making such statements. understand that this application does not create a contract of employment. I understand that, if hired, l am obliged to comply with any and all current and subsequently adopted Nelson Nursery, Inc. policies. I understand and agree that, if hired, my employment is at-will and is for no definite period of time, and may, regardless of the date of payment of wages or salary, be terminated at any time for any reason. Applicant's Signature Date ESSENTIAL JOB FUNCTIONS Our company has several types of positions. Each has essential job functions listed below. Please respond to the questions for the position for which you are applying. You may apply for more than one position. Store sales cashier Can you walk and stand on the job for the duration of a shift (typically 6-8 hours)? YesNo Can you frequently bend and squat reach, lift, carry, push, and pull with items (l-25 lbs) for ringing up, stocking, and unloading merchandise? YesNo Can you work near lawn and garden chemicals, cleaners, plants and soil? YesNo Can you work Saturdays, Sundays, and holidays (Mother's Day & Memorial Day) if it is required of the position? YesNo Can you operate a touch screen computer with occasional keyboard typing? YesNo Greenhouse Staff (general staff and/or sales) Can you walk and stand on the job for the duration of a shift (typically 6-8 hours)? YesNo Can you frequently bend, squat, reach, lift, carry, push, and pull with items up to 25 pounds as necessary for stocking, unloading, and reaching hanging plants for customers? YesNo Can you work Saturdays, Sundays, and holidays (Mother's Day & Memorial Day) if it is required of the position? YesNo Can you work near products such as lawn and garden chemicals, cleaners, plants, and soil? YesNo Can you work in the sun (greenhouse/nursery) for up to 8 hours? YesNo Loading/Stock/Field Staff Can you walk and stand on the job for extended periods of time-up to 8 hours? YesNo Can you frequently bend, squat, reach, lift, carry, push, and pull with items as required for stocking, loading, and harvesting/processing produce, plants, and merchandise? YesNo Can you lift at least 50 lbs? YesNo Can you work Saturdays, Sundays, and holidays (Mother's Day & Memorial Day) if it is required of the position? YesNo Can you work near lawn and garden chemicals, cleaners, plants and soil? YesNo Have you ever operated equipment such as forklifts or skid steers? YesNo Please add any comments or additional information that you feel is relevant. I certify that my responses above are correct and nothing to my knowledge would limit me from performing the functions listed. Signature Date Please stay on page until your application has been submitted. Thank You.