Application for Employment

Employment Record
Please give an accurate, complete full-time and part-time employment record starting with your most recent employer.
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Date Employment Began
MM slash DD slash YYYY
- Still Employed
Date Employment Terminated
MM slash DD slash YYYY
Starting Wage
Ending Wage
Name of Supervisor
Name of Position Occupied
Reason for Leaving
May we contact this employer for reference?
- Yes
- No
Additional Information:

Education
High School Name*
Location of High School
Number of Years Attended High School
Please enter a number from 0 to 9.
Did you graduate High School?*
- Yes
- No
- Not Yet
- GED
College or University Name*
Location of College or University
Number of Years at the College or University
Please enter a number from 0 to 9.
Did you graduate?
- Yes
- No
- Not Yet
Other Education (please specify):
Accomplishments
Authorized Consent*
- I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal and that my employment is dependent on truthful answers to the foregoing inquiries. Campbell’s Nurseries is formally committed to providing equal employment opportunities and will not discriminate against any employee or applicant because of race, color, religion, sex, age, national origin, disability, marital or veteran status. In consideration of my possible employment, I agree to conform to the rules and regulations of Campbells Nurseries and my employment compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself. I understand that my employment with the company is not governed by any express or implied contract of employment, either written or oral.

Position(s) Desired