John Shelley's Garden Center & Nursery, Inc.
13579 Winterstown Road, Felton, PA 17322
717.246.1414
www.gdnctr.com

APPLICATION FOR EMPLOYMENT

Pre-Employment Questionnaire   —   An Equal Opportunity Employer
PERSONAL INFORMATION

Date                 /             /                                                                      S.S.#                                                                                       

Name (last)                                                                       (first)                                 (middle)                                                               

Present Address (street)                                                  (city)                                             (state)                       (zip)                         

Permanent Address (street)                                              (city)                                      (state)                              (zip)                        

Phone Number                                                                                            Date of Birth (DOB)                                                           

Are You A U.S. Citizen?       yes         no           Or A Legal Alien?      yes           no

EMPLOYMENT REQUESTED

Position                                                                    Date You Can Start                                      Salary Desired                             

Are You Employed Now?                                      May We Contact Your Present Employer?                                                      

Ever Applied To This Company Before?                                            When ?                                                                                 

EDUCATION
School Level Name/Location of School No. of Years Attended Graduate? Subjects Studied
Grammar School

 

        
High School

 

        
College

 

        
Trade, Business or
Correspondence
Schools
        

GENERAL & US MILITARY EXPERIENCE

Subjects of Special Study or Research Work:

 

U.S. Military or Naval Service:

 

 

Rank:
Present Membership In
National Guard or Reserves:

EMPLOYMENT HISTORY
(Start With Most Recent.)
Employer/ Supervisor's Name        Address/ Telephone Number      Job Position/ Ending Salary Years of Service
 

 

      
 

 

      
 

 

      

PERSONAL & BUSINESS REFERENCES
Name Address/ Telephone Number Business Years Acquainted
1

 

      
2

 

      
3

 

      

APPLICANT 'S STATEMENT

"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORlZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE. PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LlABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND AND AGREE THAT, IF HIRED. MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE."

SIGNATURE                                                                                                                                       DATE                                               

The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.