Full Legal Name (including middle)AddressMailing Address (if different)PhoneCell PhoneEmail Are you legally eligible for employment in the United States?YesnoDesired Position Full Time Part Time Seasonal Position DesiredPay DesiredDate Available To BeginSpecial Skills & Experience(languages, programming, computers, office machines, shop machines, employment related crafts in which you have experience)EducationEducationSelect Highest Grade Completed123456789101112If you do not have a high school diploma, do you have an equivalency diploma?YesNoPost High School EducationSelect number of years of post high school education1234567Do you have a degreeYesNoDegree Major or SpecialtyLicense (to include Drivers, Certificates or Other Authorization to practice a trade or profession)Please list the following information: Type - Document Number - Expiration Date - Issued ByReferencesReference #1Please include reference's NAME, PHONE NUMBER and RELATIONSHIPReference #2Please include reference's NAME, PHONE NUMBER and RELATIONSHIPReference #3Please include reference's NAME, PHONE NUMBER and RELATIONSHIPMiscellaneousDo you have transportation to and from work?YesNoHave you ever been convicted of a felony?YesNoFelony ExplanationIf you have been convicted of a felony, please provide the following information: WHEN, WHERE and NATURE OF OFFENSEWho referred you to Urban Growers?If no one referred you, how did you hear about Urban Growers?May we contact your present employer?YesNoWork History (3 Most Recent)Employer #1Employer NameStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Starting PayEnding PayTitle / DutiesPhone NumberSupervisor Name First Last Reason for leavingEmployer #2Employer NameStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Starting PayEnding PayTitle / DutiesPhone NumberSupervisor Name First Last Reason for leavingEmployer #3Employer NameStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Starting PayEnding PayTitle / DutiesPhone NumberSupervisor Name First Last Reason for leavingWhy Should Urban Growers Hire You?Resume UploadIf you have prepared resume, please upload the file hereCertifyI here by certify that all information provided is true and complete, and I understand that the information provided is subject to verification. Falsification of any type at any time of discovery may lead to immediate termination.Full NameDate Date Format: MM slash DD slash YYYY Voluntary Self IndentificationYou may choose not to provide the following information without any adverse effect. This information is for record keeping purposes.Social Security NumberSexMaleFemaleRaceBlackWhiteHispanicAsian / Pacific IslanderAmerican Indian
