Employment Application

Personal Data

Full Name

Social Security Number

Address

Position(s) Applied For:

Are you 18 years of age or older?

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

Will you work overtime if asked?

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?

Special Skills & Qualifications:

Education

Highschool

Other

References

Reference 1

Reference 2

Reference 3

Employment History

Your present or most recent employer

Previous Employer

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.)