Plaza Flowers Job Application Instructions: Please enter your information. Answer all questions.

Personal Information

Name *

Prefix

First *

Last *

Suffix

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Phone Number *

### - ### - ####

Email Address

Driver License Number / State

Are you eligible to work in the United States? *

Yes   No

If you are under age 18, do you have an employment/age certificate? *

Yes   No  If yes, please explain:

POSITION/AVAILABILITY:

Position Applied For *

Days Available *

Monday   Tuesday   Wednesday   Thursday   Friday   Saturday   Sunday   Any

Hours Available *

AM   PM   Any  For specific Day/Hour availability, please enter information below.

Preferred Work Location *

Center City   Jeffersonville   Any  In the box below, please tell us why you want this job.

What date are you available to start work? *

MM / DD / YYYY

EDUCATION:

Name and Address Of School - Degree/Diploma - Graduation Date *

Skills and Qualifications: Licenses, Skills, Training, Awards *

EMPLOYMENT HISTORY: Present Or Last Position:

Employer: *

Address: *

Supervisor: *

Phone Number *

### - ### - ####

Email

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

Previous Position

Employer: *

Address: *

Supervisor: *

Phone Number *

### - ### - ####

Email

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

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