Application for Emplyoment


Please read this application carefully and fill out completely.

PERSONAL INFO
Name *
Name
Phone *
Phone
Address *
Address
Are you currently on lay off status and could be re-hired?
How did you hear about Winesett Nursery, Inc?
LICENSES & CLASSES
Do you currently have a valid driver's license? *
Do you currently have a valid commercial driver's license? *
Have you had any traffic violations, automobile accidents, or vehicle related convictions within the last five years? *
REQUIRED INFORMATION
Are you willing to undergo, if required by the position, a physical examination and/or blood or urine analysis? (Please note that this analysis may test for controlled substances) *
The result of any physical examination will be considered for employment purposes only as it is related to the ability to perform the essential functions of the position for which you would be employed. All results are kept confidential.
Have you ever been convicted of a felony? *
Do you have, or can you obtain the necessary documents that would permit you to work in the United States? *
Have you ever been discharge or asked to leave a job? *
EMPLOYMENT RECORD
Please begin with the most recent position you held:
Ref #1 Company Address
Ref #1 Company Address
Ref #1 Company Phone
Ref #1 Company Phone
Ref #1 Start Date
Ref #1 Start Date
First day of employment
Ref #1 End Date
Ref #1 End Date
Last day of employment
May we contact your previous employers? *
Employment Reference #2
Ref #2 Company Address
Ref #2 Company Address
Ref #2 Company Phone
Ref #2 Company Phone
Ref #2 Start Date
Ref #2 Start Date
Ref #2 End Date
Ref #2 End Date
$
$
May we contact your previous employers?
Employment Reference #3
Ref #3 Company Address
Ref #3 Company Address
Ref #3 Company Phone
Ref #3 Company Phone
Ref #3 Start Date
Ref #3 Start Date
Ref #3 End Date
Ref #3 End Date
$
$
May we contact your previous employers?
Have you ever been placed in charge of your coworkers?
EDUCATIONAL RECORD
Job requirements include, but are not limited to: 1. Being able to follow and understand written and oral directions. 2. Being in good physical condition, having the strength and endurance to perform any task required. 3. Being reliable, punctual, honest, courteous, and sober. 4. Be willing to learn and perform assigned tasks 5. Being able to work alongside others. 6. Being able to communicate with customers tactfully and courteously. 7. Being neat and clean in habit and personal appearance. You will be required to wear proper foot gear, safety glasses, ear protection, and other safety gear as needed.
Did you Graduate?
Did you Graduate?
Are you a veteran of the U.S. Military?
Can you, with or without reasonable accommodation, perform these job functions?
SIGNATURE FOR SUBMISSION
In completing this application, I understand that it is very important that I be completely truthful. I realize that Winesett Nursery, Inc. is relying on my truthfulness. I agree that if it should be discovered that the information I am providing is inaccurate, misleading, or incomplete in any respect, I will be disqualified for employment or, if I have already been hired, my employment will be terminated immediately. I understand and agree that if I should become employed by Winesett Nursery, Inc., I will have the right to terminate my employment any time for any reason, or for no reason. I further agree that Winesett Nursery, Inc. shall have the same right to terminate my employment. My employment at-will status cannot be modified unless such modification is set forth in writing in a document signed by both me and the Head Manager, Winesett Nursery, Inc.. I understand and agree that Winesett Nursery, Inc. is a Virginia Drug Free Workplace. I further agree that all job applicants and employees are subject to drug testing. As a means of maintaining our policy, we have implemented random and post accident substance abuse testing. This policy was designed with two basic objectives in mind: (1) employees deserve a work environment that is free from the negative effects of drugs and alcohol and the problems associated with their abuse, and (2) this Company has a responsibility to maintain a healthy and safe workplace.
Date of submission *
Date of submission
Today's Date
Digital Signature
Digital Signature
By filling out this digital signature, you have read and understand the foregoing and are seeking employment at Winesett Nursery, Inc. under the terms set forth herein. You certify and declare that all of the information you have provided is true and correct.