Berg’s Nursery & landscape, llc

Employment Application– Garden Center Division

Applicant Information

Last Name / First / M.I. / Date
Street Address / Apartment/Unit #
City / State / ZIP
Phone / E-mail Address
Date Available / Social Security No. / Desired Salary
Position Applied for / Driver’s License Number
Are you a citizen of the United States? / YES / NO / If no, are you authorized to work in the U.S.? / YES / NO
Have you ever worked for this company? / YES / NO / If so, when?
Have you ever been convicted of a felony? / YES / NO / If yes, explain
Do you currently have a valid driver’s license? / YES / NO
Positions at Berg’s require that you are at least 16 years of age; do you meet this requirement? / YES / NO
Some positions are Berg’s require that you are at least 18 years of age; do you meet this requirement? / YES / NO

Education

High School / Address
From / To / Did you graduate? / YES / NO / Degree
College / Address
From / To / Did you graduate? / YES / NO / Degree
Other / Address
From / To / Did you graduate? / YES / NO / Degree

References

Please list three professional references. Please do not use family members as references.
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address

Previous Employment

Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO

Military Service

Branch / From / To
Rank at Discharge / Type of Discharge
If other than honorable, explain

PRELIMINARY INTERVIEW QUESTIONS (PLEASE ANSWER ALL QUESTIONS THOROUGHLY, USE ADDITIONAL PAPER IF nECESSARY)

Why did you decide to apply for a position at Berg’s Nursery & Landscape, LLC?.
What skills will you bring to the position that you are applying for?
What did you enjoy most about your most previous job?
What did you dislike most?
Where do you see yourself in five years?
If we spoke to your previous employer, what would he/she say about your work performance?

Work Availability(Please list all hours available to work for each day)

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday

Position Responsibilites

In positions at Berg’s Nursery & Landscape, LLC you may have to complete duties including but not limited to the following:
Cashiering; customer service; direct interaction with customers; standing for long periods of time; working outside in the heat, rain or cold; watering plants, cleaning building and grounds, working directly with a wide variety of plants and chemicals; answering the telephone; taking accurate and legible written and verbal messages; unloading freight; lifting up to 40lbs alone; ability to add, subtract, multiply and divide; loading heavy merchandise into customer vehicles; completion of training program. Are you willing and able to complete all of these tasks? (Circle ONE)
YES / NO

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature / Date

OFFICE USE ONLY

Date Reviewed / Reviewed By

EM4/12