Medford: P.O. Box 2600, Medford, Oregon 97501
Hopewell: 500 Reliance Drive, Hebron, Ohio 43025
Employment Application
Qualified applicants are considered for positions without regard to race, color, religion, sex, national origin,
age, marital status, veteran or disability status or other protected class.
Please fill out completely. Incomplete applications will not be considered.
Date :
PERSONAL INFORMATION
Legal First Name (Required):
Legal Middle Name:
Legal Last Name (Required):
Address:
City:
State:
Zip Code:
Mailing Address (if different from above):
All mail will be sent to this address if filled in.
City:
State:
Zip Code:
Home Phone:
-
-
Cell Phone:
-
-
May we text your cell phone?
Other Phone:
-
-
Email Address (Required):
(For internal use only: Notification of Open Positions, Newsletters, Schedules)
Are you 18 years of age or older?
Other names used when employed or attending school:
Can you, upon employment, provide documentation
verifying your identity and your legal right to work
in the United States?
Have you ever worked for Harry & David and/or its affiliates?
If yes, where and when?
If yes, name used:
Do you speak any languages other than English?
If yes, please specify:
Position desired or area of interest:
Date Available:
To avoid the possibility of discrimination or conflict of interest, company
policy prohibits close relatives of employees from being employed in a situation
where one relative reports directly or indirectly to another, or where relatives
could affect each other's employment status (such as wages, hours, benefits,
promotions, transfers, or the like). Are any of your close relatives currently
employed by Harry & David?
If yes, who?
EDUCATION
School or Institution
Name and Location
Graduated?
Degree and Major
High School:
College or University:
Other:
EMPLOYMENT HISTORY
If presently employed, may we contact your employer to verify employment?
Please list all jobs beginning with your present or last employer. Account for all time periods including unemployment, self-employment,
and military service. If space is insufficient, list on separate page. This section must be completed even if supplemented by a resumé.
Company Name:
Street Address:
City, State, and Zip:
Telephone:
Dates of Employment:
From:
to
Position and Duties:
Supervisor's Name:
Reason for leaving:
Starting Salary/Wage:
$ /hr.
Ending Salary/Wage:
$ /hr.
Professional Reference:
Name:
Title:
Phone:
-
-
Company Name:
Street Address:
City, State, and Zip:
Telephone:
Dates of Employment:
From:
to
Position and Duties:
Supervisor's Name:
Reason for leaving:
Starting Salary/Wage:
$ /hr.
Ending Salary/Wage:
$ /hr.
Professional Reference:
Name:
Title:
Phone:
-
-
Company Name:
Street Address:
City, State, and Zip:
Telephone:
Dates of Employment:
From:
to
Position and Duties:
Supervisor's Name:
Reason for leaving:
Starting Salary/Wage:
$ /hr.
Ending Salary/Wage:
$ /hr.
Professional Reference:
Name:
Title:
Phone:
-
-
Company Name:
Street Address:
City, State, and Zip:
Telephone:
Dates of Employment:
From:
to
Position and Duties:
Supervisor's Name:
Reason for leaving:
Starting Salary/Wage:
$ /hr.
Ending Salary/Wage:
$ /hr.
Professional Reference:
Name:
Title:
Phone:
-
-
PREFERRED AVAILABILITY (Positions may require overtime and schedule flexibility, as needed. In addition,
you may be asked to perform duties other than those in your job assignment. Availability of hours may fluctuate.)
Status (Check all that apply):
Shift (Check all that apply):
Specify the earliest start time and latest end time you are available to work:
Sunday
to
Monday
to
Tuesday
to
Wednesday
to
Thursday
to
Friday
to
Saturday
to
Available start date:
REFERRAL SOURCE (Please mark ALL that apply.)
How were you referred to Harry & David (H&D)?
Please identify referral source specifically:
(Which newspaper, radio, TV station, job fair, website, school, billboard, etc?)
AREAS OF INTEREST Please check ALL areas you are interested
in and are able to perform. These are general guidelines only. Refer to full job description for specific position requirements.
POSITIONS LISTED BELOW ARE ONLY LOCATED IN MEDFORD, OREGON
PHYSICAL CAPABILITY PROFILE
Check ALL that apply:
Check only ONE below:
SKILLS
Do you have any computer skills?
Types of software you have used:
EXPERIENCE
Manufacturing:
Call Center:
Orchards:
Distribution:
FORKLIFT/TRUCK DRIVERS ONLY
CRIMINAL BACKGROUND INFORMATION
CERTIFICATION
I certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I understand that any misrepresentation of this application will result in my not being considered
for employment. I further understand that, if accepted for employment, any misrepresentation that becomes known to Harry & David may be cause for termination. I authorize the employers and supervisors listed as
references to give Harry & David any and all information regarding my previous employment and any pertinent information they may have concerning me. I release Harry & David and previous employers and supervisors
from liability for any damage that may result from furnishing information to Harry & David.
In consideration of my employment I agree to conform to the instructions, rules, and policies of the Harry & David companies. My employment and compensation can be terminated at any time, with or without cause and with or without
notice, at the option of either the applicable Harry & David company or myself. I understand that no representative of any Harry & David company, other than the President, has any authority to enter into any agreement for employment for
any specified period of time, or to make any agreement contrary to the foregoing.
"Harry & David" means Harry and David, LLC or any of its corporate affiliates.
Type Name (electronic signature):
Date:
Signature : ___________________________________________________________________________________
THIS SECTION FOR OFFICE USE ONLY
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Term Code: ______________________________________________________________________________________
No Rehire Depts: __________________________________________________________________________________
PeopleSoft Check ______________________ Entered By_____________________ Verified By______________________
Hopewell