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.

Requires sitting 5-10 hours a day and providing quality customer service. These positions require the ability to be trained in sales. A lifting capacity of a minimum of 10 lbs is required.

Requires sitting 8-10 hours a day and providing quality customer service. Ability to work with various software systems on a computer for an entire shift. Some positions may require the ability to lift, push or pull a minimum of 10 lbs.

Must have forklift experience and may be required to work in temperatures from 0-32 degrees, 8-12 hours a day. Requires repetitive bending, twisting and use of hands, wrists and arms. May be exposed to dust, hot temperatures and production noise. Must be able to lift, push or pull over 50 lbs.

Requires standing 8-10 hours a day on concrete floors. Repetitive tasks using hands, bending, reaching and twisting. Must be able to lift, push or pull a minimum of 20 lbs.
A strict dress code is enforced including removal of all jewelry.

Requires standing 8-10 hours a day on concrete floors. Repetitive tasks using hands, bending, reaching and twisting. May require working in environments of 32 degrees or less. Must be able to lift, push or pull a minimum of 30 lbs.

Requires standing 8-10 hours a day on concrete floors. Repetitive tasks using hands, bending, reaching and twisting. May require working in environments of 32 degrees or less. Must be able to lift, push or pull a minimum of 50 lbs.

POSITIONS LISTED BELOW ARE ONLY LOCATED IN MEDFORD, OREGON

Requires standing 8-10 hours a day on concrete floors. Repetitive tasks using hands, bending, reaching and twisting. Must be able to lift, push or pull a minimum of 30 lbs.
A strict dress code is enforced including removal of all jewelry.

Requires working outdoors in a variety of weather conditions 8-10 hours per day, climbing ladders, bending, reaching and twisting. Must be able to lift, push or pull a minimum of 50 lbs.


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
Experience (check ALL that apply):



In the last four months have you operated a commercial truck and/or forklift?
If no, how long ago did you operate a commercial truck and/or forklift?
Have you ever had an accident while operating a commercial truck and/or forklift?
If yes, please explain:
CRIMINAL BACKGROUND INFORMATION
Have you had any felony or misdemeanor criminal convictions in the last 7 years?
If yes, complete information below. If you have had more than four convictions in the past 7 years please continue on a separate sheet of paper and submit with your completed application. Please disclose ALL convictions, misdemeanor, or felony charges. Failure to disclose is considered a misrepresentation and you will not be considered for employment. "Will discuss at interview" is not an adequate response. Please be specific.

Date:     County/State:     Conviction:
Date:     County/State:     Conviction:
Date:     County/State:     Conviction:
Date:     County/State:     Conviction:
A conviction is not an automatic disqualification from employment.
California applicants only: You may omit convictions for marijuana-related offenses that are more than two years old or for minor traffic violations; juvenile convictions; misdemeanor convictions for which probation was completed and the case was dismissed, or any information concerning a referral to, and participation in, any pre-trial or post-trial diversion program.

Massachusetts applicants only: You may omit convictions which are older than 5 years, and may also omit convictions for public drunkenness.

Philadelphia, Pennsylvania applicants only: Please do not complete this section.
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

Math ________  Word ________  Excel ________  Access ________  Outlook ________  Typing ________  10-Key ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Date ________  Comments ______________________________________________________________  Initials/EE# ________

Term Code: ______________________________________________________________________________________

No Rehire Depts: __________________________________________________________________________________

PeopleSoft Check ______________________  Entered By_____________________  Verified By______________________

Hopewell