ࡱ> `b_'` bjbjLULU 4^.?.? 8$ )    :)<)<)<)<)<)<)$*h-`)&" &"&"`)  u)$$$&"^  :)$&":)$$$  {t"v$%l)0)$-"f-$-$ >+!,$W!${! `)`)`$R )&"&"&"&" Omni Enterprises, Inc. An Equal Opportunity Employer APPLICATION FOR EMPLOYMENT Store: ____________ Position: ____________ Date: ____________ This application form is intended to provide information for evaluating your suitability for employment, and is not intended to be, nor may it be construed to be, a contract of employment of any type whatsoever. Qualified applicants receive consideration for employment without discrimination because of sex, marital status, race, color, creed, national origin, age or the presence of non-job-related handicaps. NAME AND LOCATION (Please Print) ___________________________________________ (Last) (First) (Init.) Other Names you may have used (maiden name, etc.)_____________________________ CURRENT ADDRESS No. & Street__________________________________ Home Phone (___) _____-_____ City, State, Zip ________________________________ Mess Phone (___) ____-______ TYPE OF WORK DESIRED Position for which you are applying __________________________________________ Do you wish to work: _____ Full Time _____ Part Time ______ Temporary If part-time specify hours or days available _____________________________________ Date available to work ________________________ Rate of pay expected _________ Have you ever worked for our company before (YES / NO), If yes, State position ____________________________________________________________ Dates of employment ______________________________________________________ Reason for leaving ________________________________________________________ EDUCATION School Print Name & Complete AddressYears CompletedDegree, Major or Type of CourseHigh School College Graduate Trade, Bus or Corres. Other  MILITARY SERVICE Were you in the U. S. Armed Forces (YES / NO), if yes, what branch ______________ Dates of duty: From ________________ to _______________ Rank at Separation_____ GENERAL INFORMATION Are you legally authorized to work in the U. S.? ______ Yes ______ No Are you below the age of 18? ______ Yes ______ No Do you know of any reason why you cannot perform essential functions of the job for which you are applying with or without reasonable accommodation? (Yes / No) If yes, explain _________________________________________________________________ _______________________________________________________________________ Have you ever been convicted of a criminal offense? (Yes / No) If yes, Date _________ Place _______________________ Nature _____________________________________ (Affirmative answer will not automatically disqualify you from employment) Do you have a valid vehicle drivers license? (Yes / No) If yes, give state & license number ______________________________________________________________ EXPERIENCE Give a complete record of your work history and the reasons for periods of unemployment. Do not skip one even if you were only employed for a brief time. Start with your most recent employment. May we contact your current employer? (Yes / No) EXPERIENCE FROM TOEMPLOYER NAME & ADDRESSPOSTION/ SALARYDescribe briefly experience, skills REFERENCES (Not a relative At least three) Name & AddressOccupationPhone Person to be notified in case of emergency: Name ____________________________________ Phone (___) __________ Address _______________________________________________________ I hereby affirm that information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of either the company or myself. I understand that no management official other then the president of the company has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any) to provide any relevant information that may be required to arrive at an employment decision. Signature: ___________________________________ Date: _____________________ NO CONSIDERATION OF EMPLOYMENT WILL BE GIVEN TO ANY APPLICANT WHO DOES NOT SIGN THE ABOVE STATEMENT. Note: Additional personal information may be required to complete benefit forms after being hired. Thank you for showing an interest in pursuing a career with Omni Enterprises, Inc.. Mail your completed application and/or resume to: Omni Enterprises, Inc. 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