Martin Garden Center (MGC) is an equal opportunity employer. We will not discriminate against employees or applicants for employment on any basis prohibited by federal, state or local laws, including but not limited to race, color, religion, age, ancestry, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, veteran status, mental or physical disability, marital status, genetic information or any other protected status.
Date of application _____________ Position Desired _________________________________
How did you learn of this job? ____________________________________________________
Why are you seeking a new job at this time? _________________________________________
Date you can start __________________________________
Applicant Information
First Name __________________ Middle _____________ Last Name _________________
Street Address ____________________________ City/State/Zip _________________________
Email Address __________________________ Phone Number ________________________
Social Security No. ________________
Are you legally eligible for employment in the U.S.? ___________
(If hired, E-Verify will be used to determine your eligibility to work in the U.S.).
If the position for which you are applying requires driving:
Drivers License No._____________ State __________ Expiration Date __________
Are you a veteran? If yes, please give dates of service: ________________________________
Have you been convicted of a felony within the last 7 years? _______
If so, please give the date and place of the conviction (including any plea of guilty), and describe the nature of the crime. Do not include any convictions which have been expunged or sealed. Convictions will not result in automatic disqualification for employment as MGC will consider all relevant factors, including the nature and gravity of the offenses, the time that has passed and the nature of the position being sought. ___________________________________________
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Employment Information
Are you seeking full time, part time, seasonal or temporary employment? ________________
What hours and shifts would you prefer to work? _____________________________________
List any times that you are NOT available to work ___________________________________
Are you willing to work overtime? _____ Weekends? _____ Holidays? _______
Are you currently employed? _____ If so, please state your employer ____________________
Have you ever worked for MGC? ___ If yes, please give the dates and the name that you used at that time ____________________________________________________________________.
Have you ever been discharged or asked to resign from any position? _______ If yes, please describe the circumstances. _______________________________________________________
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Are you able to perform all the tasks of the position for which you are applying, to include lifting up to 50 lbs. of weight unassisted, with or without reasonable accommodation? (If necessary, please refer to any attached job description). Please describe which tasks, if any, you will need accommodation to perform and explain what type of accommodation you may need. ______________________________________________________________________________
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Education (Circle highest level achieved)
Elementary: 1 2 3 4 5 6 7 8 Secondary: 9 10 11 12 GED
Name of School: _____________________ Name of School: ______________________
Location of School: ___________________ Location of School: ___________________
College: 1 2 3 4
Name of School: _________________________________
Location of School: _______________________________
Degree or Major: _________________________________
Employment History (Begin with most recent)
- Employer: _________________________ Phone No. ___________________
Address: ___________________________ City/State/Zip; _______________
Dates of Employment: From _______ to _______ Salary: _______________
Position: ______________ Supervisor’s Name and Title: _________________
Duties: __________________________________________________________
Reason for leaving: ________________________________________________
- Employer: _________________________ Phone No. ___________________
Address: ___________________________ City/State/Zip; _______________
Dates of Employment: From _______ to _______ Salary: _______________
Position: ______________ Supervisor’s Name and Title: _________________
Duties: __________________________________________________________
Reason for leaving: ________________________________________________
- Employer: _________________________ Phone No. ___________________
Address: ___________________________ City/State/Zip; _______________
Dates of Employment: From _______ to _______ Salary: _______________
Position: ______________ Supervisor’s Name and Title: _________________
Duties: __________________________________________________________
Reason for leaving: ________________________________________________
- Employer: _________________________ Phone No. ___________________
Address: ___________________________ City/State/Zip; _______________
Dates of Employment: From _______ to _______ Salary: _______________
Position: ______________ Supervisor’s Name and Title: _________________
Duties: __________________________________________________________
Reason for leaving: ________________________________________________
May we contact the employers listed above? ________ If not, please list the employers that you do not wish us to contact. Also, identify all other names that you may have used when you worked for these employers. _______________________________________________
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Applicant’s Certification and Release
Please read the following statement carefully before signing to indicate your understanding:
I certify that the information provided in this application/resume is true and complete. To the best of my knowledge. I understand that any false, misleading or incomplete information, statements, or omissions, such as prior employers, shall be grounds for rejection of this application or for termination of my employment regardless of when such information is discovered. I agree to immediately notify MGC if I should be convicted or a felony while my job application is pending or during my employment, if hired.
I authorize MGC and its agents and employees to investigate all information contained in this application for employment. I authorize my references and background sources to disclose information about me to MGC without giving me prior notice of such disclosure. I specifically authorize MGC and its agents and employees to investigate my personal, criminal, employment and credit history. I hereby release MGC, my former employers and all other information sources from any and all claims, demands, or liabilities arising out of or in any way related to securing such information or disclosures.
I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed at any time thereafter. If requested, I will take a post-job offer physical examination, which may include an alcohol or drug test.
I understand that nothing contained in this application or conveyed to me prior to or during my employment is intended to create an employment contract between MGC and me. I understand and acknowledge that, if hired, my employment relationship with MGC will be at-will, which means that I may resign at any time, and MGC may discharge me at any time, for any reason or no reason, so long as that reason does not violate the law. It is further understood that this at-will employment may not be altered or amended by anyone except the owner of MGC.
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Signature date
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Printed name