EDUCATION
Bashaw Valley Ent. Inc.D.B.A. Bashaw Valley Farm & Greenhouse
Employment Application                                        W7402 Fox Trail Rd. Shell Lake WI 54871   (715)468-2591
APPLICANT INFORMATION
Last Name
 First                                               M.I.
 Date
Street Address
 PO Box
 Apt. #
City
 State
 Zip
Home Phone
 Cell
 Work
Date Available
 Social Security No.
 Desired Wage range per Hour
Position Applied for
    
High School
 Address
     State                             Zip
From                       To
 Did you graduate?
 Yes
 No
 Degree
College/Tech.
 Address
     State                             Zip
From                       To                    
 Did you graduate?
 Yes
 No
 Degree
College/Tech.
 Address
     State                             Zip
From                       To
 Did you graduate?
 Yes
 No
 Degree
REFERENCES-Please list three professional references
Full Name
 Relationship
Company
 Phone
Address
 Cell Phone
Full Name
 Relationship
Company
 Phone
Address
 Cell Phone
Full Name
 Relationship
Company
 Phone
Address
 Cell Phone
PREVIOUS EMPLOYMENT
Company
 Phone
Address
 Supervisor
Job Title
 Starting Wage $                 Ending Wage $
Responsibilities
  
From                                      To
 Reason For Leaving
May we contact your previous supervisor for a reference?
 Yes ___              No___
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature                                                                                              Date
Are you a citizen of the United States?
 Yes
 No
 If no, are you authorized to work in the U.S.?     Yes            No
Do you have any previous greenhouse experience?
 Yes
 No
 If so, when and how long?
Have you ever been convicted of a felony?
 Yes
 No
 If yes, explain
 
 
Company
 Phone
Address
 Supervisor
Job Title
 Starting Wage $                 Ending Wage $
Responsibilities
  
From                                      To
 Reason For Leaving
May we contact your previous supervisor for a reference?
 Yes ___              No___
Company
 Phone
Address
 Supervisor
Job Title
 Starting Wage $                 Ending Wage $
Responsibilities
  
From                                      To
 Reason For Leaving
May we contact your previous supervisor for a reference?
 Yes ___              No___