Name*

DOB*

Phone*

Email*

Address*

Date Available From*

To

Leave blank if open-ended.

What are your interests in the horticulture field?*

Desired Hourly Pay?*

Do you have any prior experience in the industry?*

If yes, please explain:

Tree, Shrub, & Perennial identification

5

1 = I don’t know anything, 10 = I can name it all

Identification of common New England weeds

5

1 = I don’t know anything, 10 = I can name it all

Are you allergic to bees? Do you have any other allergies we should be aware of?

Business

Phone

Contact Person

May we Contact Them?

Yes No

Employed From

To

Starting Pay

Ending Pay

Responsibilities

Reason for Leaving

Business

Phone

Contact Person

May we Contact Them?

Yes No

Employed From

To

Starting Pay

Ending Pay

Responsibilities

Reason for Leaving

Name

Phone

Relationship

How Long Have you Known Them?

Are you a US Citizen?

Yes No

Are you legally allowed to work in the US?

Yes No

Have you ever been convicted of a felony?

Yes No

If so, please explain:

If you were a plant, what kind of plant would you be?

Anything else you would like us to know?

I certify that my answers are true and complete to the best of my knowledge.

Signature (type your full name)*

Date*

Wanna join the PB Team?

Applicant Information

Availability

Horticulture Background

Skills (1–10)

Health & Allergies

Previous Employment (1)

Previous Employment (2)

Personal Reference

Eligibility

Just for fun

Disclaimer & Signature