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Employment Application
Position: 

Your Contact Information
Name:
   
Have you ever used another name? If yes, please provide:

Address 1:

Address 2:

City:

State:

Zip Code:

Phone:

Fax:

Email:

EDUCATION
 Name and address of Educational Institutions  Major Subject  Minor Subject  Diploma or Degree
 High School:    YesNoGED
 College:    YesNo
 Graduate School:    YesNo
 Other:    YesNo

Do you meet the minimum qualifications for hire into this position(s)? YesNo
If no, candidates who are seeking consideration on the basis of equivalency must submit the attached supplemental application for equivalency determination.
Academic honors:

Please list job-related organizations, clubs, professional societies, or other associations to which you belong. You may omit those which indicate your race, religious creed, color, national origin, ancestry, sex, age, sexual preference, political beliefs or physical handicap.

If use of a language other than English is relevant to the job for which you are applying, please list all languages other than English which you read, speak or write. In addition, please indicate whether you speak, write, and/or understand the other language.

EXPERIENCE
 Please begin with present or most recent experience; include both paid and voluntary experience.
 Fill out this completely; do not mark "see resume."
 
 From Mo/Yr  To Mo/Yr  EMPLOYER - Name and Address  Supervisor's Name and Phone Number
   
 Position Title:   Full-Time  Part-Time  
 Duties Performed:


 
 From Mo/Yr  To Mo/Yr  EMPLOYER - Name and Address  Supervisor's Name and Phone Number
   
 Position Title:   Full-Time  Part-Time  
 Duties Performed:


 
 From Mo/Yr  To Mo/Yr  EMPLOYER - Name and Address  Supervisor's Name and Phone Number
   
 Position Title:   Full-Time  Part-Time  
 Duties Performed:


 
 From Mo/Yr  To Mo/Yr  EMPLOYER - Name and Address  Supervisor's Name and Phone Number
   
 Position Title:   Full-Time  Part-Time  
 Duties Performed:

OTHER EMPLOYMENT REFERENCES
EMPLOYER SUPERVISOR'S NAME PHONE NUMBER

I authorize any current or former employer, former school or college attended, or any person listed as a supervisor and/or reference, to provide information to Lisa Arnold Nursery Sales about my present or prior employment, prior educational experience, or any other information relating to my application for employment.

By submitting this application, I declare of certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.