Online Applicaton Form

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NEW APPLICATION

RESUME APPLICATION

First time to apply a job position? Fill out this job application.

If you have already created an unfinished application and want to finish it.


Date	Last Name*	First Name*	Middle
01/02/2025

Current Address
No. Street*	City*	State*	ZIP Code*



Email*	Cell Phone*	Alternative Phone
	--	--


	Are you applying for
	Regular full-time work?*	YES NO
	Regular part-time work?*	YES NO



	Are you available for work on the weekends?*	YES NO
	Would you be available to work overtime, if necessary?*	YES NO

	Employment Desired	You must select regular work or temp work
	Position applying for*


	If hired, what date can you start work?*
	Salary desired: ( Hourly Rate )*

	Personal Information

	How did you hear about our company and this opening?*


	Have you ever applied to or worked for our company before?*	YES NO
	If yes, when?
	Do you have friends or relatives working for our company?*	YES NO
	If yes, state name and relationship.
	Name Relationship


	If hired, would you have a reliable means of transportation to and from work?*	YES NO
	Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)*	YES NO
	If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?*	YES NO

School	Name	Address (City, State)	# of years completed	Did you graduate	Degree or Diploma
High School				YES NO
College / University				YES NO
Vocational / Business				YES NO
Graduate School				YES NO
Health Care Training				YES NO

	Do you have any other experience, training, qualifications, or skills that you feel make you especially suited for work at our company? If so, please explain:


Are you licensed / certified for the job applied for?	YES NO
Name of license / certification:		Issuing State
License/ certification number:
Has your license/ certification ever been revoked or suspended?	YES NO

	If yes, state reason(s), date of revocation or suspension, and date of reinstatement.

	page 3 of 6

	Employment History

	List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment.


	--> YES to fill in your info \| NO to cancel



	Temporary work, e.g., summer or holiday work?*	YES NO


	--> YES to fill in your info / NO to cancel

	Education,Training and Experience


	Name of Employer*		Telephone No*
	Type of Business*		Supervisor's Name*


	Name of Employer		Telephone No
	Type of Business		Supervisor's Name

	References

	List below three persons not related to you who have knowledge of your work performance within the last three years.

	Please provide a brief description of your relationship and the capacity in which you know them.*

	Please Read Carefully and Click Yes for Each Paragraph

	I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
	I have read the paragraph above YES NO


	I hereby authorize OEMassive to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
	I have read the paragraph above YES NO


	I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and OEMassive. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or OEMassive, and that no promises or representations contrary to the foregoing are binding on OEMassive unless made in writing and signed by me and OEMassive's designated representative.
	I have read the paragraph above YES NO


	Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by OEMassive, I am entitled to copies of any such public records unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.
	I have read the paragraph above YES NO


	In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
	I have read the paragraph above YES NO


	I waive receipt of a copy of any public record described in the paragraph above.