Application for Employment

Personal Information

First Name:   Middle: Last:   Address:     City:   State:   Zip Code:

Telephone Number:

Position(s) Applied For:

Have you ever worked for this company before   YesNo

Rate of pay expected   List special licenses or skills/machinery you can operate Name relatives/friends working for Opportunity House

Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expumged or sealed by a court? If yes, please describe in full.	YesNo

	Name and Location of School	No. of Years Attended	Did You Graduate	Subjects Studied/Majored
Elementary School			YesNo
High School			YesNo
College/University			YesNo
Trade/Bus. School			YesNo

Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties
Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties
Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties
Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties
Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties
Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties
Dates of Employment	Name, Address & Phone Number of Employer. Include Name of IMMEDIATE Supervisor	Salary/Hourly Wage	Reason for Leaving
From: To:
Position Description of Duties

I have read and completed all of the material and information contained in this Employment Application form. I verify that all of the information I have supplied is true and correct to the best of my knowledge, information and belief, and that I have not withheld any information requested. I understand that in the event that I am hired by OPPORTUNITY HOUSE, and it is later determined that I made a material misrepresentation or failed to provide certain information requested, I may be subject to immediate discharge by the Company. I authorize any former employer, person, firm, corporation; or government agency to answer any and all questions and to release or provide any information, within their knowledge or records and agree to hold any or all of them blameless and free of liability for releasing any truthful information that is within their knowledge or records (check one) including my present employer excluding my present employer. In consideration of my employment I agree to conform to the rules and regulations of the Company. This application is not an employment contract.  

As an at-will employee either I or OPPORTUNITY HOUSE can terminate employment at any time, for any or no reason, with or without notice.

I Have Read and Agree To The Above Statements

I understand that the Company will require, prior to employment, urine samples to determine drug or alcohol contamination. I realize that a positive drug/alcohol test will disqualify me from employment. If an offer of employment is made, the company will require a physical evaluation to determine fitness for duty.

I authorize you or another entity to make such investigations and inquiries of my employment, criminal history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or individuals from all liability in responding to inquiries in connection with my application.

I Have Read and Agree To The Above Statements