Demographic Information

Date of Application*:   

How where you referred to us?*   

Name*:  

Street Address*:   

City*:       State*:   Maryland Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming   

Zip Code*:  

Email Address*:  

Phone Number*:   Home Work Cell

Phone Number 2 :   Home Work Cell

Employment Data

Date Available to Start*:  

Salary Requirment*:  

Are you at least 18 years of age or can you require a work permit?*   Yes No

If no, please explain:  

Have you ever worked for Kurt Bluemel, Inc.?*   Yes No

If yes, when?  

Are you a citizen of the United States?*   Yes No

If not, do you have documents to allow you to work in the United States?   Yes No

Type of employment desired? (Full Time, Part Time, Seasonal)*  

Have you ever pleaded "guilty", "no contest", or been convicted of a crime?*   Yes No

If yes, please provide dates and details:

Answering "yes" to these questions does not constitutue an automatic rejection for employment. Date of the offense, seriouslness and nature of the violation, rehabilitation, and postion applied for will be considered.

Do you have a valid driver's license?*   Yes No

Last Education Completed*   Date:

Please summarize your special skills or qualifications*:

Previous Employement History

Job 1

Dates of Employement: From: To:

Position:

Company:   

Street Address:   

City:       State:   Maryland Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming   

Zip Code:  

Supervisor Name:  

Supervisor Title:  

Phone Number:   Home Work Cell

Starting Title:      Starting Salary:  

Ending Title:      Ending Salary:  

Reason for Leaving:

---

Job 2

Dates of Employement: From: To:

Position:

Company:   

Street Address:   

City:       State:   Maryland Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming   

Zip Code:  

Supervisor Name:  

Supervisor Title:  

Phone Number:   Home Work Cell

Starting Title:      Starting Salary:  

Ending Title:      Ending Salary:  

Reason for Leaving:

---

Job 3

Dates of Employement: From: To:

Position:

Company:   

Street Address:   

City:       State:   Maryland Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming   

Zip Code:  

Supervisor Name:  

Supervisor Title:  

Phone Number:   Home Work Cell

Starting Title:      Starting Salary:  

Ending Title:      Ending Salary:  

Reason for Leaving:

By submitting the information below the applicant attests that they are able to legally seek employment in the United States and the following certifications:

• I certify that the information contained in this application is correct to the best of my knowledge.
• I understand that to falsify information is grounds for Kurt Bluemel, Inc. refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, educational and qualifications for employment.
• I also authorize Kurt Bluemel, Inc. to request and receive such information.
• In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted any any time, at Kurt Bluemel, Inc. sole option and without prior notice to me.
• I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of Kurt Bluemel, Inc. or myself.

Kurt Bluemel, Inc. does not discriminate in employment, educational programs, and activities on the basis of race, national origin, color, creed, religion, sex, age, disability, veteran status, sexual orientation, gender identity, or associational preference.. Non-discrimination does not guarantee an employee or member of the public any rights not otherwise provided by law. Those without a passion for horticulture need not apply.

By the applicant entering their name in the box below, they are electronically signing this application and it carries the same legal value as if it were signed by the applicant in person.