Application

PERSONAL DATA

First
Last
Middle
First
Last
Middle
Street
City
State
Zip
Street
City
State
Zip
The Civil Rights Act of 1964 amended by the Equal Employment Opportunity Act of 1972 and the Age of Discrimination in Employment Act of 1967 and the Rehabilitation Act of 1973 prohibit discrimination in employment practices because of race, color, national origin, sex, handicap, religion or age.

EDUCATION

Be sure to indicate any specific courses of study or experience in horticulture, botany, floriculture, greenhouses, etc.
High School
School Attended
Address
Years Attended
Major
Degree or Diploma
College or University
School Attended
Address
Years Attended
Major
Degree or Diploma
Special Training / Trade School
School Attended
Address
Years Attended
Major
Degree or Diploma
Other
School Attended
Address
Years Attended
Major
Degree or Diploma

Volunteer Work/Internships

Organization
Position
Dates of Service
Contact Number
Organization
Position
Dates of Service
Contact Number
Organization
Position
Dates of Service
Contact Number
Organization
Position
Dates of Service
Contact Number

REFERENCES
(Other than relatives)

First
Last
First
Last

SERVICE RECORD

EMPLOYMENT RECORD

I hereby certify that the information given in this application is true and correct. I understand that any answers contrary to the truth may be grounds for dismissal or refusal to hire and that nothing has been withheld that would effect my employment. If employed, I understand that I must furnish information required pertaining to birth date, sex, race, citizenship, marital status and number of dependents. I understand my driving record & criminal record in the State of Oklahoma or pervious state of residence will be checked prior to permanent employment.

Due to the nature of the industry and the Oklahoma DDSD requirements, we ask that you attach a copy of a valid driver’s license.

Full Name

OTHER PERTINENT INFORMATION