Application for Employment

Personal Information
Name *
Name
Address *
Address
Is this your Permanent Address *
Employment Desired
Position *
Employment Type *
Date you are able to start *
Date you are able to start
Compensation per hour
$
Are you currently employed? *
If you are employed, may we inquire of your present employer? *
Have you ever applied to this company before? *
Education History
Name and Location of High School
Did you Graduate High School?
Name and Location of High School
Did you Graduate College
Name and Location of School
Did you Graduate Trade/Business/Correspondence School
General Information
Former Employers
List your last three employers, starting with most recent first.
Employed From
Employed From
Employed To
Employed To
$
Employed From
Employed From
Employed To
Employed To
$
Employed From
Employed From
Employed To
Employed To
$
References
Give below the names of two persons not related to you, whom you have known at least one year.
Reference 1 *
Reference 1
Business Address *
Business Address
Reference 2 *
Reference 2
Business Address *
Business Address
Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the companies from all liabilities for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorize company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. In compliance with federal law, all persons hired will be required to verify identity and eligible to work in the United States and to complete the required employment eligibility verification document upon hire.
You agree to the aforementioned authorization *
Signature *
Signature
Date *
Date

Brigiotta’s Farmland Produce & Garden Center, Inc. (herein, Brigiotta’s) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Brigiotta’s complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Brigiotta’s expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Brigiotta’s employees to perform their job duties may result in discipline up to and including discharge.