Employment Application

Applicant's Information

Applicant's First Name *

Initial

Applicant's Last Name *

Address *

City *

State

Zip *

Cell Phone *

Email *

Are you at least 16 years of age?

Yes

Have you ever been convicted of a crime?

Yes

If you have been convicted of a crime, please explain

Emergency Contact

Name *

Phone *

Education

High School *

City / State *

Dates Attended *

College

City / State

Dates Attended

Position Details

Preferred Location(s)

Tucson

Employment Status

Full-Time

Part-Time

Position Applying For *

Desired Hours Per Week *

PLEASE LIST AVAILIBITY: Monday - Saturday 7:00am-8:00pm, Friday until 9:00pm and Sunday 9:00am-6:00pm. Holidays will have a different schedule. Subject to change.

Day	SUN	MON	TUE	WED	THUR	FRI	SAT
From
To

Previous Employment

Current Employer (if applicable)

City/State

Supervisor

Phone

Start Date

Ending Date

Starting Pay

Ending Pay

Previous Employer

City/State

Supervisor

Phone

Start Date

Ending Date

Starting Pay

Ending Pay

Previous Employer

City/State

Supervisor

Phone

Start Date

Ending Date

Starting Pay

Ending Pay

Electronic Signature

My Initials

I agree with the Conditions and Certifications for Employment

Captcha

Mayfield Florist does not discriminate on the basis of race, color, national origin, sex religion, age, disability or veteran status, or any other criterion made unlawful under applicable federal or state laws. You are not required to give information responsive to inquiries prohibited by law.

YOU MUST READ AND SIGN THE FOLLOWING CONDITIONS AND CERTIFICATIONS:

In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me including previous employers, schools, consumer credit, criminal convictions, motor vehicle, and other reports. These reports may include information as to my character, work habits, performance, educations, compensations and experience along with reasons for termination of employment from previous employers. Furthermore, I understand that Mayfield Florist may be requesting information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and I hereby consent to Mayfield Florist obtaining the above information from the previous employers, various governmental activities and agencies and from the provided reference. I hereby release from all liability or responsibility all persons, companies, organizations or corporations furnishing such information to Mayfield Florist and as well as Mayfield Florist, Mayfield Florist of America Inc and any other affiliates who may be the recipients of such information.

I certify that the information I have furnished on this application form is true and complete. I understand that any misleading or incorrect statements, verbally or in writing, or the incomplete filling out of the application may render this application void and, if employed, may be cause for immediate dismissal.

I understand I must provide satisfactory documents to establish my identity and right to work in the United States, if I am offered a position with the company and the failure to provide this evidence will result in the termination of my employment.

All hiring and employment by Mayfield Florist is at will. I understand this application is not an employment contract, nor can it be used to create one. Employment by Mayfield Florist has no specific term and may be terminated by the employee or Mayfield Florist with or without notice. I acknowledge that Mayfield Florist has not made any promises or representations that differ from those contained in this paragraph. This at-will provision may only be modified or waived by a written agreement signed by the President and me. I further understand that I am responsible for being familiar with Mayfield Florist policies and I understand that Mayfield Florist has complete discretion to modify its policies, rules, regulations and practices at any time, to the extent permitted by federal, state and local law. If I am employed with Mayfield Florist, I consent to any such changes.