Application

First*

Last*

Address*

City*

State*

Zip Code*

Cell Phone*

Home Phone

Email*

Are you at least 18 years of age?*

Yes
No

Note: If under age 18, hire is subject to verification of minimum age to work.

What position are you applying for?*

Start Date

If hired, do you have a reliable means of transportation to and from work?*

Yes
No

Do you have a Missouri Drivers License:*

Yes
No

If yes, Missouri Drivers License No:

Do you have a Commercial License:*

Yes
No

If yes, Commercial License No:

Do you have a D.O.T. Card?*

Yes
No

Do you have a past conviction of a D.W.I. or D.U.I?*

Yes
No

If hired, can you present evidence of your identity and legal right to work in this country?*

Yes
No

Are you available to work:*

Full Time
Part Time
Seasonal

Days / Hours available to work:*

Which Of The Following Skills Do You Have?*

Do you have any mechanical experience?*

Yes
No

If yes, please list type(s) of mechanical experience:

Please list any other experience, job-related skills, additional languages, or other qualifications that you would like us to consider in evaluating your qualifications for employment:

Have you worked for Baxter Gardens West before?*

Yes
No

If yes, please provide dates and position:

Do you know any current or former employees of Baxter Gardens West?*

Yes
No

If yes, please provide names and relationship to you:

Employment Experience

Please list the names of your present or previous four employers with most recent employer listed first. If self-employed, provide business name and provide business references.

Former Employers

Name of Employer	Address	Phone	Supervisor	Position	Start & End Date	Reason for Leaving	May We Contact?	Salary

Have you ever been involuntarily terminated or asked to resign from any job?*

Yes
No

Education

High School

School Name	Diploma/Degree (Yes or No)	Area of Study/Major	Year of Graduation

College/University

School Name	Diploma/Degree (Yes or No)	Area of Study/Major	Year of Graduation

Trade School

School Name	Diploma/Degree (Yes or No)	Area of Study/Major	Year of Graduation

Certifications

School Name	Diploma/Degree (Yes or No)	Area of Study/Major	Year of Graduation

References

List the names of three persons not related to you whom you have known for at least one year.

References*

Name	Phone or Email	Business	Years Acquainted

Authorization*

I ATTEST TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL THE FOLLOWING TERMS.

I authorize Baxter Gardens West to thoroughly investigate my work record, education, references, and other matters related to my suitability for employment and further, authorize my prior employers and listed references to disclose to Baxter Gardens West any information related to my work records, without giving me prior notice of such disclosure.

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration law requires me to complete an I-9 form in this regard.

I certify that the information provided by me in this application are true and correct to the best of my knowledge. I further certify that I, the applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate termination if I am employed, regardless of the time elapsed before discovery.

If hired, I understand and agree that my employment with Baxter Gardens West is at will and that neither I nor the company is required to continue the employment relationship for any specific term. I further understand that Baxter Gardens West or I may terminate the employment relationship at any time, with or without cause, and with or without notice.

Employment Experience

Education

References

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