Pre-Employment Application

PERSONAL AND GENERAL INFORMATION

Applying for position as
Full name
Home Telephone
Email
Address Line 1
Address Line 2
City
State
Zip
Can you, after an offer of employment, submit verification of your legal right to work in the U.S.?
Are you over 18 years of age?
Can you work overtime and/or during weekends if needed?
Have you ever applied for employment with United Floral Exchange?
If yes, indicate location and date
Have you ever been employed by United Floral Exchange?
If yes, indicate location and date
Are you able to perform the essential functions of the job for which you are applying, whether with or without reasonable accomodation?

EDUCATION

SCHOOL SCHOOL NAME AND ADDRESS YEARS ATTENDED? SUBJECTS STUDIED DID YOU GRADUATE? DEGREE RECEIVED
High School Yes
College/
University		 Yes
Vocational/
Business		 Yes
List any special skills you may have
List any computer programs you have used
Is there anything else you'd like us to know?

CURRENT AND FORMER EMPLOYERS

List below your last three employers; begin with current or most recent employer:
EMPLOYMENT DATES EMPLOYER INFORMATION IMMEDIATE SUPERVISOR INFORMATION
From
To
Name
Address
Phone
Name
Title
SALARY REASON FOR LEAVING
$
EMPLOYMENT DATES EMPLOYER INFORMATION IMMEDIATE SUPERVISOR INFORMATION
From
To
Name
Address
Phone
Name
Title
SALARY REASON FOR LEAVING
$
EMPLOYMENT DATES EMPLOYER INFORMATION IMMEDIATE SUPERVISOR INFORMATION
From
To
Name
Address
Phone
Name
Title
SALARY REASON FOR LEAVING
$
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)?
If yes, state the nature of the crime(s), when and where convicted and disposition of the case

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the positions(s) applied for may, however, be considered.)

PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH


Initials		 I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

Initials		 I hereby authorize United Floral Exchange to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Initials		 I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company’s designated representative.