Full Legal Name (including middle) Address Mailing Address (if different) PhoneCell PhoneEmail Are you legally eligible for employment in the United States? Yes no Desired Position Full Time Part Time Seasonal Position Desired Pay Desired Date Available To Begin Special 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? Yes No Post High School EducationSelect number of years of post high school education1234567Do you have a degree Yes No Degree Major or Specialty License (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 RELATIONSHIP Reference #2Please include reference's NAME, PHONE NUMBER and RELATIONSHIP Reference #3Please include reference's NAME, PHONE NUMBER and RELATIONSHIP MiscellaneousDo you have transportation to and from work? Yes No Have you ever been convicted of a felony? Yes No Felony 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? Yes No Work History (3 Most Recent)Employer #1Employer Name Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Starting Pay Ending Pay Title / Duties Phone NumberSupervisor Name First Last Reason for leavingEmployer #2Employer Name Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Starting Pay Ending Pay Title / Duties Phone NumberSupervisor Name First Last Reason for leavingEmployer #3Employer Name Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Starting Pay Ending Pay Title / Duties Phone NumberSupervisor Name First Last Reason for leavingWhy Should Urban Growers Hire You?Resume UploadIf you have prepared resume, please upload the file hereMax. file size: 100 MB.CertifyI 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 Name Date 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 Number Sex Male Female Race Black White Hispanic Asian / Pacific Islander American Indian
