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Employment Application

  • Personal Data

  • Full Name

  • Social Security Number

  • Address

  • Cell Phone

  • Email Address

  • Position(s) Applied For:

  • Are you 18 years of age or older?

  • YesNo
  • **If under 18, we need you to furnish us with a working permit.**
  • Are you legally authorized to work in the United States?*

    YesNo
  • Date available for employment

  • Are you able to meet the attendance requirements of the position?

  • YesNoN/A
  • Will you work overtime if asked?

  • YesNo
  • Have you ever been convicted of any crime, the record of which has not been expunged and that is other than a minor traffic violation?

  • YesNo
  • Special Skills & Qualifications:

  • Education

  • Highschool

  • Other


  • References

  • Reference 1

  • Reference 2

  • Reference 3

  • Employment History

  • Your present or most recent employer

  • Employment Dates

  • Previous Employer

  • Employment Dates

  • List any other jobs not covered above


  • Please Read Carefully

  • The facts set forth in my application are true and complete. I authorize the investigation of all statements contained in this application and hereby authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from all liability on account of furnishing such information. I understand that if employed, false statements, omissions or misleading statements on this application shall be considered sufficient cause for dismissal and I agree that my employer shall not be held liable in any respect if my employment is terminated because of such omissions or false or misleading statements. Omni Resource, Inc./Blair Construction, LLC is hereby authorized to investigate my employment history, including the contacting of the employers listed on the previous page. (If there is a particular employer you do not wish contacted, please indicate which one and why.)

  • Signature

  • Date