Bloomington Valley Nursery
Application for Employment
Bloomington Valley Nursery
5230 S Old St Rd 37
Bloomington, In 47401
812-824-8813
thevalley@yahoo.com
*Bloomington Valley Nursery is an Equal Opportunity Employer. BVN provides
employment opportunities without regard to race, color, religion, sex, national origin,
age, handicap, sexual orientation or veteran status.
Directions: Please write your response above each line unless otherwise indicated. All
answers must be printed or typed. Answers that are illegible or incomplete may prevent
us from considering your application.
Personal Data
______________________________
First Name
___________
Middle
__________________________
Last Name
_______________________________________________
Current Address
City
___________ __________
State
Zip Code
_______________________________________________
Permanent Address (if different)
___________ __________
State
Zip Code
_________________________________
Telephone Number
______________________________
Additional Contact Information
_________________________________
Social Security Number
______________________________
Date of Birth
Are you a U.S. Citizen? ____________
If you answered no above, are you authorized to work in the United States? ___________
Visa # and expiration date: ________________________________________________
Education
Name and address of High School: ___________________________________________
________________________________________________________________________
Dates attended: From________________________ To ___________________________
Did you graduate?_________
Year of graduation? _________ Degree:_____________
Name and address of Trade/Technical School: _________________________________
________________________________________________________________________
Dates attended: From________________________ To___________________________
Did you graduate?_________ Year of graduation? ___________ Degree:____________
Name and address of College attended: ______________________________________
_______________________________________________________________________
Dates attended: From_______________________ To____________________________
Did you graduate?_________
Year of graduation? _________ Degree:_____________
Major/Majors? __________________________________________________________
List any Scholarships, Academic Honors, Awards or Special Achievements:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Employment History
Starting with your present or most recent employer, list in consecutive order, all
employment and periods of unemployment since you graduated from or last attended
high school. Additional employment may be listed on separate sheet if necessary.
1. Full name and address of company:_________________________________________
________________________________________________________________________
Telephone number: _________________ Wages earned: _________________________
Dates employed: From________________________ To__________________________
Reason for leaving: _______________________________________________________
Title of Position: ____________________ Name of Supervisor: ____________________
Describe your duties and responsibilities: ______________________________________
________________________________________________________________________
________________________________________________________________________
2. Full name and address of company: ________________________________________
________________________________________________________________________
Telephone number: _________________ Wages earned: _________________________
Dates employed: From_______________________ To__________________________
Reason for leaving: _______________________________________________________
Title of Position: ____________________ Name of Supervisor: ____________________
Describe your duties and responsibilities: ______________________________________
________________________________________________________________________
________________________________________________________________________
3. Full name and address of company: ________________________________________
________________________________________________________________________
Telephone number: _________________ Wages earned: _________________________
Dates employed: From_______________________ To__________________________
Reason for leaving: _______________________________________________________
Title of Position: ____________________ Name of supervisor: ____________________
Describe your duties and responsibilities: ______________________________________
________________________________________________________________________
________________________________________________________________________
Other Employment
List any part-time employment while in school (if not listed above), including Company
name, Address, Dates of employment:
________________________________________________________________________
________________________________________________________________________
Are there any periods of unemployment and/or part-time employment which are not
listed above or on separate sheet? If so, please explain:
________________________________________________________________________
________________________________________________________________________
Have you ever been suspended, placed on probation, asked to resign, discharged or
terminated? If so, please explain:
________________________________________________________________________
________________________________________________________________________
Position Information
What position are you applying for? __________________________________________
How did you hear about our company? ________________________________________
Are you willing to work long hours, including weekends? _________________________
If your hours are limited list the days and times you will be available:
Sunday: ________________________________________________________________
Monday: ________________________________________________________________
Tuesday: ________________________________________________________________
Wednesday: _____________________________________________________________
Thursday: _______________________________________________________________
Friday: _________________________________________________________________
Saturday: _______________________________________________________________
Have you ever been employed by this company before? _______ If so, when? _________
Are any relatives, including in-laws, employed at this company? ___________________
If so, list name, relationship and position: ______________________________________
________________________________________________________________________
Have you previously applied at this company? __________ If so, when? _____________
Skills
Indicate experience in years and months for each area.
Use of commercial mowers_________________________________________________
Use of skid steer loaders____________________________________________________
Use of fertilizer spreaders___________________________________________________
Irrigation installation_______________________________________________________
Tree/shrub/plant installation_________________________________________________
Tree/shrub trimming_______________________________________________________
Can you lift 50lbs? ____________________ 100lbs? ____________________________
Do you have the stamina to work 12 hour days when necessary? ____________________
Can you work in the heat of the sun? _______ In the rain? ________ In the cold?_______
Can you perform under constant deadlines? __________ Are you willing to move
between different types of jobs on a continual basis? ___________
If you have used commercial mowers and/or skid steer loaders, indicate which brands and
models: _________________________________________________________________
________________________________________________________________________
Do you have experience driving a truck pulling a trailer with equipment? _____________
If so, how much experience? ________________________________________________
Can you back a trailer into tight spots? __________
Do you have any mechanical experience with small engines, vehicles? _______________
Explain: ________________________________________________________________
Do you have experience in construction/concrete work (i.e. setting forms)? ___________
Explain: ________________________________________________________________
Do you have experience using transit/survey equipment? __________________________
Explain: ________________________________________________________________
Do you have the ability to read and implement a design plan? ______________________
Explain: ________________________________________________________________
Do you have knowledge of plant material, including trees, shrubs, perennials and annuals
and their care and a willingness to further your education? ___________________
Explain: ________________________________________________________________
Do you have computer experience which would be of value to the company? ________
Explain: ________________________________________________________________
Do you have other office skills not previously listed? ___________________
Explain: ________________________________________________________________
Do you have experience handling money and making change? _____________________
Customer care is a priority at Bloomington Valley Nursery and requires excellent
communication skills, patience, and a pleasant attitude. Are you willing to work each
shift scheduled and provide the best customer care possible, through personal
interaction, phone conversations and via email? _______________________
Miscellaneous Information
Do you have a valid driver’s license? ________ License # _________________________
State ________________________ Expiration Date ____________________________
Have you ever been convicted of or sentenced for ANY violation of the law? _________
If so, give full details (the existence of a criminal record does not constitute an automatic
denial of employment)_____________________________________________________
_______________________________________________________________________
Military Service and Status
Branch of service ____________________ Military occupation ____________________
Length of active duty (month/year) ___________ Date of entry ____________________
Date of separation _______________ Rank at separation _________________________
Applicant’s Certification and Agreement
I hereby certify that my answers to the foregoing questions are true and complete and that I have not
knowingly withheld any facts, circumstances or other information that would, if disclosed, affect my
application. I further understand that any false or misleading statement or omission of pertinent
information will result in the rejection of my application or in dismissal if discovered subsequent to my
employment.
I hereby affirm that by execution of the application, I acknowledge that the company has disclosed to me
that an Investigative Consumer Report, including information as to my character, general reputation,
personal characteristics, and mode of living may be made.
I hereby authorize the company to request, and I also authorize and request, that each former employee,
school attended, and each person, firm, or corporation given as references above, to furnish at any time,
information which may be sought concerning me and my work habits, character or skill, and any other data
required.
I hereby confirm that by submitting this application I agree to submit to medical evaluations, including tests
for the presence of any illegal drugs or alcohol, prior to and during my employment, within a time period
prescribed by the company and as often as directed by employment.
I hereby authorize the medical examiner to disclose to the company any and all findings arrived at in any
examination performed either prior to or during employment.
I understand that should I be given employment, such employment shall be for an indefinite period of time
and may be terminated at any time for any reason by myself or the company without notice or liability
whatsoever, except for unpaid wages earned by the date of termination.
I understand that if I am employed, this application and the company’s Terms of Employment and Policy
and Procedures, as amended from time to time by the company will govern the terms and conditions of my
employment.
The company operates under the principles of affording equal employment opportunity through affirmative
action for qualified handicapped individuals, veterans of the Vietnam era, and disabled veterans. All
applicants and employees who believe themselves to be members of one or more of these groups, and who
wish to indentify themselves as such for the purpose of affirmative action consideration are invited to do
so.
Submission of this information is voluntary and refusal to provide it will not subject you to discharge or
disciplinary treatment. Information obtained concerning individuals shall be kept confidential, except that
one (1) supervisor and manager may be informed regarding disabled veterans and handicapped individuals,
as necessary, two (2) first aid and safety personnel may be informed, when and to the extent appropriate, if
the condition might require emergency treatment., and three (3) governmental officials investigation
compliance will be informed.
Signature ____________________________________________ Date _____________________
Thank you for submitting this application. It will remain under consideration for six months. It will not be
necessary for you to reapply within this six month period. Your interest in BVN is appreciated.