Retail Employment Application – Nelson Nursery, Inc.

PERSONAL INFORMATION

Full Name

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.