20601 S. LaGrange Rd. · Frankfort, IL 60423 · 815-469-104410255 Wicker Ave. · St. John, IN 46373 · 219-365-0882
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"WE PUT THE COLOR IN GREEN"6517 S. First Line Road • La Porte, IN 46350 • email@example.comOffice Phone: (219) 393-3607 • Greenhouse Phone: (219) 393-1100 • Fax: (219) 365-1190
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This application is designed to be completed and submitted electronically. If you wish to complete and mail a paper application, you may print this application and mail it to:
Date: Feb 10, 2011
Last Name First Name Middle Initial
Street City State ZIP
Phone () Cell Phone ()
Are you 18 years or older? Yes No
Are you legally eligible for work in this country? Yes No
Position applied for Salary desired
Date available for work
Ever applied with us before? Yes No If so, when?
Are you employed now? Yes No If so, may we inquire with your employer? Yes No
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Employee - Name
Please check the area(s) in which you are interested:
GrowerGeneral LaborPlanting CrewManagementOfficeOther
Availability: Flexible availability has much to do with who we call for interviews and hire - especially evenings and weekends.
Total number of hours available per week
Provide the following information for your current and past employers, starting with the most recent. Explain any gaps in employment in the comments section below.
Employer Name Supervisor's Name City Phone Number
Position From / To / (mo/yr)
Start Salary End Salary
Job Duties Reason for leaving
Position From / To / (mo/yr)
Which of these jobs did you like best and why?
Subjects of special study or research
U.S. Military Service Rank Membership in National Guard or Reserves? Yes No
Why do you want to work at Alsip Home & Nursery?
What do you consider to be your greatest strength?
What do you consider to be your greatest weakness?
List the name and telephone number of three school or personal references who are not related to you.
1. Name Phone Number Years Known
2. Name Phone Number Years Known
3. Name Phone Number Years Known
List any other information you would like us to consider
Have you ever been convicted of a crime other than a misdemeanor? (This does not include any sealed or expunged records, only convictions)
If Yes, please explain:
Kingsbury Acres has made a strong commitment to being a drug-free workplace. All job applicants being considered for employment at Kingsbury Acres will undergo testing for the presence of illegal drugs as a condition of employment. Anyone confirmed to have a positive test result will be denied employment. Kingsbury Acres does not discriminate against applicants because of past history of drug abuse, therefore, any individual who fails a pre-employment drug test may initiate another inquiry after a period of no less than six months and present themselves as drug free.
I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from employer's service, whenever it is discovered.
I give the employer the right to contact and obtain information from all references, employers, criminal history*, motor vehicle record and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.
I give the employer the right to contact and obtain information from all references, employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.
The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.
This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.
This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.
I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for reasonable accommodation as required by the ADA.
I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
Please read the following before submitting your application:
I am aware that all positions require reference checks, and that some positions require background checks and other pre-employment qualifications. I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment. In the event of employment, I understand that falsification or omission of information in any application, interview(s), personnel forms or any other Kingsbury Acres document may result in discharge. I also authorize the companies, schools, or persons named above to give any info regarding my employment, character and qualifications. I hereby release said companies, schools, or persons from all liability for any damage for issuing this information. I understand that it is policy of Kingsbury Acres to provide equal opportunity and make all employment decisions without regard to race, color, age, sex, marital status sexual orientation, ancestry, religion, and national origin, citizenship, disability, or medical condition. However, I understand and agree that my employment, if hired, is for no definite period and may, regardless of the date of payment of any wage and salary, may be terminated at any time, at will, with or without cause, without previous notice. I further understand that neither this document or any statement by Kingsbury Acres should be understood to create a contract of continuing employment. As a condition of employment, I agree to fully and completely comply with all policies concerning alcohol, drugs, safety, theft, and loss control, and further consent to such searches, inspections, examinations, and tests as may be required by policy.
*The employer will not require nor will you be asked to report whether you have a sealed or expunged conviction or whether you have an arrest.
Initials (By placing your initials in this box you are certifying to the above statement)
Signature of Applicant Date: Feb 10, 2011
You can also include a resume with the application. Click on the 'Browse' button and locate your resume to upload.
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