Date *

MM

DD

YYYY

Cell Number

(###)

###

####

Phone Number *

(###)

###

####

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you 18 years of age or older? *

Yes

No

If hired, can you provide written evidence that you are authorized to work in the U.S.? *

Yes

No

Date Service Began:

MM

DD

YYYY

Date Service Ended:

MM

DD

YYYY

Type of Work Desired - Garden Center or Landscape *

Garden Center

Landscape

Designer

Office

Do You Have Any Previous Injuries Or Work Restrictions? *

Yes

No

Is there any information we would need about your name, or use of another name, for us to be able to check your work record? *

Yes

No

APPLICANT'S STATEMENT/AGREEMENT/AUTHORIZATION *

I understand that The Mustard Seed follows an employment at will policy, in that I or The Mustard Seed may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this employment at will policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief operating officer of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of wages. I hereby agree that if I am hired and later choose to sever my employment with The Mustard Seed, Inc., I will give a minimum of two weeks written notice of intent to terminate employment or accept minimum allowed wages for all days or hours owed me. I understand this application will be active for a period of one year; after that time, if I wish to be considered for employment, I must submit a new application. I understand that The Mustard Seed may thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information. I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

I have read the above statement and agree