FLOWERAMA Application for Employment

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LAST NAME
 FIRST NAME
 Middle Initial
 Email Address
 Today's Date
PHYSICAL ADDRESS
CITY, STATE
 PHONE
- - OR - -
Are you authorized to work in the
United States? Yes No		 HAVE YOU BEEN CONVICTED OF
A CRIME? Yes No		 ARE YOU AT LEAST 16 YEARS OLD?
Yes No
ARE YOU BI-LINGUAL?
Yes No		 WHAT LANGUAGES DO YOU SPEAK?
 DESIRED POSITION
Customer Service Designer Delivery Management
DESIRED HOURS: Full-time Part-time Seasonal/Temporary from to
STORE LOCATION:
AVAILABILITY: Days Evenings Saturdays Sundays Holidays WHEN CAN YOU START?
Emergency Contact: Name      Phone

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SCHOOL NAME, CITY & STATE COURSE OF STUDY DATES
ATTENDED 		DEGREE
HIGH SCHOOL Diploma
Yes No
TECHNICAL TRADE
COLLEGE
GRADUATE SCHOOL

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If applicable, may we contact your current employer? Yes No
COMPANY
 Physical Address
City, State, ZIP
Phone Number
- -

Dates of Employment
/ to /

Supervisor
 Starting Pay
 Ending Pay
Job Functions
Reason for Leaving
COMPANY
 Physical Address
City, State, ZIP
Phone Number
- -

Dates of Employment
/ to /

Supervisor
 Starting Pay
 Ending Pay
Job Functions
Reason for Leaving
COMPANY
 Physical Address
City, State, ZIP
Phone Number
- -

Dates of Employment
/ to /

Supervisor
 Starting Pay
 Ending Pay
Job Functions
Reason for Leaving

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I certify that all the information contained in this application is true and correct. I authorize Flowerama of America, Inc. to verify the above information. I understand that any misrepresentation of facts in this application may disqualify me of obtaining employment with Flowerama of America, Inc. I further understand that Flowerama of America, Inc. makes hiring choices based on the skills, experience and availability of all applicants and that this application will be kept on file in accordance with all state and federal regulations. If I am extended a job offer and do not successfully complete post-offer requirements and/or have misrepresented my skill level, I understand that the offer will be rescinded.

I Accept (Required) Yes   Signature Date