Name *

First

Last

Home Address *

How Many Years Have You Lived At This Address? *

Main Phone Number *

Alternate Phone Number

Email *

Emergency Contact Name and Emergency Phone Number *

Position Applied For *

Desired Salary *

When Are You Able To Start Work *

How Many Hours a Week Can You Work? *

What Hours/Days Would You Like to Work?

No Preference
See My Selections Below

Sunday

Monday

Tuesday

Wednesday

Thursday

Saturday

Friday

Do You Have a Drivers License? *

Yes
No

Do You Have Reliable Transportation? *

Yes
No

All positions require some physical activity, extended periods of standing and walking and ability to work in non-air conditioned environments. Also, must be willing to assist customers in a friendly way with their needs. Are you able to perform these tasks? *

Yes
No

Have You Ever Been Convicted of a Crime? *

Yes
No

If yes, explain number of convictions, nature of offense leading to conviction, how recently such offenses were committed, sentences imposed and types of rehabilitation.

Please Indicate the School You've Most Recently Attended with Name & Location

What Was the Last Grade Completed?

Still Enrolled?

Yes
No

Please list any scheduling conflicts such as sports, clubs, other jobs, daycare, school. Also list any already scheduled vacations or appointments. *

Please list previous employment for past 3 years with job title or job description that you did for the company with supervisor name and contact information and reason for leaving. *

May We Contact Your Current Employer? *

Yes
No

Feel free to use this space for any additional information you would like to share.

I understand that Bi-Water Farm & Greenhouse may do a background check, at their expense, through the Kentucky State Police on me if I am chosen for employment and I will give the information that will be necessary for the background search. Applicants may also be tested for illegal drugs. By checking the box below, I am indicating I understand this statement and all of the information in this application is correct. *

I understand the statement above and verify that all information in this form is correct.

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