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EMPLOYMENT APPLICATION

THE GREEN HOUSE OF CARLTON INC

It is the policy of The Green House of Carlton Inc. to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicant Name:

Address:

City/State/Zip:

Number of years at this address:

Daytime Phone: Evening Phone:

Social Security Number:



Emergency Contact: Who should be contacted if you are involved in an emergency?

Contact Name:

Relationship to you:

Address:

City/State/Zip:

Daytime Phone: Evening Phone:

Job Position applied for:

Salary Desired: $ per

Who referred you to our company?

Have you applied to our company previously? Yes No

If yes, when?

Are you at least 16 years old? Yes No

How will you get to work?

Driver’s License Number:

What state issued your license?

Are you willing to shift, including afternoons and weekends? Yes No

If no, please state any limitations:

If you are offered employment, when would you be available to begin work?




Applicant’s Skills:

List any skills that be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Ability or Skill Years of Experience Rating
1 2 3 4 5

1 2 3 4 5



Applicant Employment History: List your current or most recent employment first.

Employer Name:

Address:

City/State/Zip:

Reason for Leaving:

Dates of Employment (Month/Year):


Employer Name:

Address:

City/State/Zip:

Reason for Leaving:

Dates of Employment (Month/Year):


Employer Name:

Address:

City/State/Zip:

Reason for Leaving:

Dates of Employment (Month/Year):



Applicant’s Education and Training:

College Name and Address:

Did you receive a degree: Yes No If yes, degree received:

High School Name and Address


Last Grade? 9 10 11 12 Diploma: Yes No

Other Training (graduate, technical, vocational):


Awards, Honors, Special Achievements:


References: List any two people who will be willing to provide a reference for you.

Name:

Address:

City/State/Zip:

Telephone:

Relationship:

Name:

Address:

City/State/Zip:

Telephone:

Relationship:


Please provide any other information that you believe should be considered:



CERTIFICATION

I certify the information provided on the Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences, immediate termination.

I authorize The Green House of Carlton Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed or behalf of the organization by it’s representative the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of The Green House of Carlton Inc., except in a specific written contract of employment signed on behalf of the organization by it’s representative has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULL READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
APPLICANT SIGNATURE DATE

Employer Use Only
Start Date: Wages: Location: