Date:

Name:
                  Last                               First                               Middle

Address:
                      Number                      Street                                                        City                                      Country                           Postal Code

Home Telephone # Mobile Phone #

Email Address:

For what position are you applying?

PLEASE NOTE: Candidates for driver positions will also require a driving background check.

Are you interested in working full or part time? If part time, how many hours per week:

Please indicate below your hours of availability during the week. Please note that you are only indicating your availability. These hours are not work schedules. (For example, Mon. 8am-8pm , Tues. 8am-9pm )

Mon.: Tue: Wed: Thu: Fri: Sat: Sun:

If hired, when would you be available to work?

Why do you want to work for Omnis Group?

What skills, knowledge or experience would you bring to Omnis Group?

EMPLOYMENT HISTORY
References will be contacted. Please be sure information is current and complete.

1. Present or Most Recent Employer: Telephone:

Address: Employed From: to

Position Held: Salary:

Description of Duties:

Reason for Leaving:

Name of Supervisor:

May We Contact?
Yes
No

2. Prior Employer: Telephone:

Address: Employed From: to

Position Held: Salary:

Description of Duties:

Reason for Leaving:

Name of Supervisor:

May We Contact?
Yes
No

3. Prior Employer: Telephone:

Address: Employed From: to

Position Held: Salary:

Description of Duties:

Reason for Leaving:

Name of Supervisor:

May We Contact?
Yes
No

4. Prior Employer: Telephone:

Address: Employed From: to

Position Held: Salary:

Description of Duties:

Reason for Leaving:

Name of Supervisor:

May We Contact?
Yes
No

RECORD OF EDUCATION

Last School (Name, City, Country): Course of Study:

Years Completed: Diploma/Degree:

College (Name, City, Country): Course of Study:

Years Completed: Diploma/Degree:

Other (Name, City, Country): Course of Study:

Years Completed: Diploma/Degree:

What is your basic salary requirement:

Have you ever been convicted of a crime within the last seven (7) years?
Yes
No

(Do not answer Yes if the conviction has been pardoned, annulled, expunged, sealed or impounded by a court.)
Conviction will not necessarily disqualify applicant from employment.

If Yes, please give the conviction date and nature of the offense:

Do you know anyone who is currently employed by us? If so, who?

How did you learn of Omnis Group?

Have you ever filed an application with us before? If so, when?

Were you previously employed by us? If so, when?

Are you at least 18 years old?
Yes
No    If not, can you provide proof that you are legally permitted to work?

PROFESSIONAL/WORK REFERENCES
Only list those people with whom you have established business relationships

Name: Position: Company:

Phone: Relationship to Applicant:

Name: Position: Company:

Phone: Relationship to Applicant:

Name: Position: Company:

Phone: Relationship to Applicant:

PRE-EMPLOYMENT CERTIFICATION

I understand that this application is only valid for the position applied for at present and that the Company is not obligated to retain or consider this application for future openings.

Initial:

I understand that the Company may conduct an investigation of all statements contained in this application and my suitability for employment with the Company. I UNDERSTAND THAT ANY FALSIFICATION, MISREPRESENTATION OR OMISSION BY ME OF INFORMATION CONTAINED IN OR REQUESTED BY THIS APPLICATION WILL RESULT IN IMMEDIATE TERMINATION FROM EMPLOYMENT OR REMOVAL OF MY APPLICATION FROM CONSIDERATION. I authorize the Company to secure information concerning my suitability for employment with the Company from all references, former employers, education institutions, public agencies and/or licensing authorities, and for those parties to provide such information to the Company. I hereby waive and release any and all claims I have or may have against any person or entity arising from any request for or gathering or disclosure of such information.

Initial:

I UNDERSTAND THAT IF I AM EMPLOYED BY THE COMPANY, MY EMPLOYMENT CAN BE TERMINATED, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE, AT ANY TIME FOR ANY LAWFUL REASON AT THE OPTION OF THE COMPANY OR MYSELF. I also acknowledge and understand that this employment application is not, nor is it intended to be, a contract of employment, and that no manager, supervisor or representative of the Company, other than the President of the Company, has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Initial:

ENTERING MY NAME BELOW CERTIFIES THAT I HAVE READ AND UNDERSTAND THE FOREGOING AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE INFORMATION ON THIS FORM IS TRUE AND CORRECT. MY NAME BELOW ALSO CERTIFIES THAT I AGREE TO BE BOUND BY THE TERMS AND CONDITIONS IN THIS APPLICATION.

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