Employment Application

 

      If you are interested in working for Gumpf Gardens, Inc., please print out the application below and bring it, in person, to Gumpf Gardens, Inc.,  766 Shenango Road, Beaver Falls, PA 15010.          

     Be sure to check our web-site for our hours of operation or call 724-843-1930.

Employment Application

 

 


 PERSONAL  DATA                                                   DATE: _______________

 

 

 

 


Name:             _____________________________________________________________

 

            Last                                                      First                                         Middle

 

 

 

Address:        _____________________________________________________________

 

                        Street  Address                                                City                   State                Zip Code

 

 

 

Phone #: ( ___ ) _____ – _______     Social Security #:  _______-_____-_________

 

 

 

Age (check):      o 21 or Over        o 18-20        o 16-17       o Under 16

 

If Under 16, Date of Birth: _________________   email address:_____________________

 

 

 

Division Applied For (check):          o  Garden Center     o  Landscape

 

 

 

Are you a resident of ChippewaTownship?   o  Yes    o  No

 

 

 

Did you pay Occupational Privilege Tax  (OPT) for the current year?    o  Yes    o  No

 

 

 

Are you applying for (check):     o  Full-time    o         Part-time       Date Available: ____________

 

 

 

How many hours per week would you like to work? _______

 

 

 

Are you attending school ?   o  Yes    o  No

 

 

 

If “yes,”  what days and hours: _______________________________________________

 

 

 

List hours you are available to work each week:

 

 


  Monday        Tuesday        Wednesday  Thursday         Friday         Saturday        Sunday

 

 


From:      To:         From:      To:         From:      To:         From:      To:         From:      To:         From:      To:         From:      To:                                                                                                                                          

 

 

 

 


Do you have reliable transportation to work?  o  Yes    o  No

 

 

 

List any friends or relatives working for us: _______________________________________

 

 

 

Have you ever been convicted of a felony or misdemeanor?  o  Yes    o  No

 

 

 

Describe:________________________________________________________________

 

 

 

Have you any physical defects which keep you from performing certain jobs? o  Yes    o  No

 

 

 

Explain:__________________________________________________________________

 

 

 

Check if you have had any of the following conditions:

 

 

 

  • o Allergies     o Heart condition     o Diabetes       o Hernia       o Back injuries/problems

 

 


Gumpf  Gardens,  Inc.

 

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Do you consider yourself to be mechanically-inclined?           o  Yes    o  No

 

 

 

Have you ever operated or worked on greased equipment?    o  Yes    o  No

 

 

 

Can you operate a vehicle with a manual transmission?           o  Yes    o  No       

 

 

 

Can you operate a skid loader?   o  Yes    o  No       Can you operate a forklift?   o  Yes    o  No

 

 

 

 Can you operate a vehicle pulling a trailer?  o  Yes    o  No

 

 

 

Do you have a valid driver’s license ?  o  Yes    o  No   Driver’s license #: _________________

 

 

 

Do you have a commercial driver’s license ?    o  Yes    o  No           

 

 

 

Can you lift 50 pounds ?    o  Yes    o  No             Can you lift 100 pounds ?    o  Yes    o  No

 

 

 

Of what achievement in your life are you most proud? _______________________________

 

________________________________________________________________________

 

 

 

What are your personal strengths? _____________________________________________

 

 

 

What are your weakest areas? ________________________________________________

 

 

 

What are your five year goals? ________________________________________________

 

 

 

Why do you want this particular job? ________________________________________________________________________________________________________________________________________________

 

 


  EDUCATIONAL  BACKGROUND

 

 


High School:  _____________________________________________________________

 

                                    (Name of school)                                                 (Course of study or degree earned)

 

 

 

College:           _____________________________________________________________

 

                                    (Name of school)                                                 (Course of study or degree earned)

 

 

 

Other:                        _____________________________________________________________

 

                                    (Name of school)                                                 (Course of study or degree earned)

 

 

 

Circle  Highest  Grade  Completed:      High School                 College                GraduateSchool

 

                                                                                               

 

                                                            9    10    11    12            1    2    3    4    5                     1    2    3    4

 

 


   PERSON  TO  BE  NOTIFIED  IN  CASE  OF  EMERGENCY

 

 


Name:                         ____________________________         Relationship: __________________

 

 

 

Address:        ____________________________

 

 

 

                        ____________________________         Telephone #: __________________

 

Gumpf  Gardens,  Inc.

 

Page 3 of 4

 

 

 

     EMPLOYMENT & ARMED SERVICES EXPERIENCE – Enter most recent position first

 

 

 

 

 

 

 

 

 

 

 

 

 


1)________________________    ______________________     ____________________

 

                 (Employer’s Name)                             (Supervisor’s Name)                              (Your Position)

 

 

 

   ________________________    ______________________    ____________________

 

           (Employer’s Street Address)                 (Employer’s Telephone #)                            (Pay rate)

 

 

 

   ________________________    From:________ To:________    ____________________

 

              (Employer’s City & State)                                         (Dates Employed)                        (Reason for leaving)

 

 

 

2)________________________    ______________________     ____________________

 

                 (Employer’s Name)                             (Supervisor’s Name)                               (Your Position)

 

 

 

   ________________________    ______________________    ____________________

 

           (Employer’s Street Address)                 (Employer’s Telephone #)                            (Pay rate)

 

 

 

   ________________________    From:________ To:________    ____________________

 

              (Employer’s City & State)                                          (Dates Employed)                        (Reason for leaving)

 

 


3)________________________    ______________________     ____________________

 

                 (Employer’s Name)                             (Supervisor’s Name)                              (Your Position)

 

 

 

   ________________________    ______________________    ____________________

 

           (Employer’s Street Address)                 (Employer’s Telephone #)                            (Pay rate)

 

 

 

   ________________________    From:________ To:________    ____________________

 

              (Employer’s City & State)                                          (Dates Employed)                        (Reason for leaving)

 

 


References

 

The following is a list of persons whom Gumpf Gardens, Inc. may contact to verify qualities I may possess, such as, honesty, integrity and my work-ethic.

 

 

 

1)________________________    ______________________     ____________________

 

                 (Reference’s Name)                                (Telephone #)                            (Relationship to Applicant)

 

 

 

2)________________________    ______________________     ____________________

 

                 (Reference’s Name)                                (Telephone #)                            (Relationship to Applicant)

 

 

 

3)________________________    ______________________     ____________________

 

                 (Reference’s Name)                                (Telephone #)                            (Relationship to Applicant)

 

 

 

 


Gumpf  Gardens,  Inc.

 

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I understand that my employment will be on a two week probationary basis.  I understand that acceptance of an offer of employment does not create a contractual obligation on the part of the employer to continue to employ me in the future. 

 

I understand that this job requires working outdoors in all types of weather. I further understand that I must come to work prepared for outdoor conditions.

 

            I give permission to make any investigation of my credit record and to inquire about my work history with any or all previous employers.

 

            All of the information I have supplied in this application is a full and complete statement of the facts, and it is understood that should any falsification be discovered it will constitute ground for dismissal.

 

            The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin.  Federal law also prohibits discrimination on the basis of age with respect to certain individuals.

 

 

 

________________________________             ___________

 

                                               (Signature)                                                              (Date)

 

 


           

 

I give Gumpf Gardens, Inc. my permission to obtain my motor vehicle records from the appropriate authorities as the ability to legally drive may be a condition of my employment.

 

 

 

________________________________             ___________

 

                                               (Signature)                                                              (Date)

 

 

 

 


            As a condition for this application to be considered, I understand and agree to undergo substance screening, if required.  I understand that should my test results prove positive I shall not be considered further by Gumpf Gardens Inc. for employment.

 

            I hereby authorize Gumpf Gardens Inc. or any medical professional retained by Gumpf Gardens Inc. for screening purposes to conduct such screening and to provide such results to Gumpf Gardens Inc.  I release Gumpf Gardens Inc. and any person affiliated with this company and any such institution or person conducting the screening from liability.

 

 

 

________________________________             ___________

 

                                               (Signature)                                                              (Date)