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Employment Application |

Applicant Information
Application Date:  (mm / dd / yyyy)
Last Name:
 First Name:
 M.I.
Street Address:
 		Apartment/Unit#:
City:
 State:
 Zip Code:
Phone Number:
 Email Address:
Date Available:
 Position Desired:
 Full Time  Part Time  Full or Part Time		 Salary Desired:
Position Applying For: 
Are you a citizen of the United States?  Yes  No
  -  If no, are you authorized to work in the US?    Yes  No
Have you ever worked for this company?  Yes  No
  -  If yes, when? 

Have you ever worked for a Florist?  Yes  No

  -  If yes, where and for how long? 

Have you been convicted of a felony?  Yes  No
  -  If yes, please explain:
     

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:
Full Name: 
Relationship: 
Company:  Phone:
Full Name: 
Relationship: 
Company:  Phone: 
Full Name: 
Relationship: 
Company:  Phone: 

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:
     

Disclaimer and Submission
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. I authorize investigation of all statements contained on this application and included resume. I further authorize you to contact my references and previous employers to verify the information contained herein.
 

Wesley Berry Flowers is an Equal Opportunity Employer.