Employment Application

1 Personal Information

2 Education

3 Previous Employment

4 References

5 Additional Information

6 Agreements

7 Submit Your Information

Additional Experience or Qualifications
List any other experience, skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualifications for employment.
Please indicate any prior military training which you would like considered in connection with your application for employment.
Employment History
Please attach Resume
Have you ever been employed?*
- Yes
- No
Previous Employment
List present and past employment, beginning with your most recent.
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Worked From:
To:
Reason for Leaving:
Job Title
Rate of Pay:
Supervisor's Name
Supervisor's Title
Summary of Duties
Add Previous Employer?*
- Yes
- No
Previous Employment
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Worked From:
To:
Reason for Leaving:
Job Title
Rate of Pay:
Supervisor's Name
Supervisor's Title
Summary of Duties
Add Previous Employer?*
- Yes
- No
Previous Employment
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Worked From:
To:
Reason for Leaving:
Job Title
Rate of Pay:
Supervisor's Name
Supervisor's Title
Summary of Duties

Personal or Business References
Opportunities, Inc. requires that applicants provide at least 3 personal or business references. Please DO NOT list any persons related to you.
Reference #1
Reference #1*
Title*
Relationship*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*
Phone*
How long known?*
Reference #2
Reference #2*
Title*
Relationship*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*
Phone*
How long known?*
Reference #3
Reference #3*
Title*
Relationship*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*
Phone*
How long known?*

APPLICANT STATEMENT
I certify that all information I have provided in order to apply for and secure work with Opportunities, Inc. is true, complete and correct. Falsification of any information will be deemed grounds to reject a candidate or terminate employment if already hired. I expressly authorize, without reservation, Opportunities, Inc., it representatives, employees or agents to conduct a personal investigation as to my qualifications, experience, background, etc. and in so doing, to contact any person, law enforcement agency or prior employer it desires. I authorize release of any information regarding any criminal convictions that may exist against me. I hereby waive any and all rights and claims I may have regarding Opportunities, Inc., its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all persons, corporations or organizations for furnishing such information about me. I understand that I will be required by law to have a criminal records check and possibly fingerprinting and that conviction of certain criminal offenses will automatically bar employment. I certify that I do not have any detectable amounts of prohibited substances in my system at the time of taking my pre-employment drug screen (if applicable). I understand that if my drug screen turns out positive for a prohibited substance, I will not be eligible for hire, or if I am hired pending the outcome of such a test, I will be subject to immediate termination. I understand that Opportunities, Inc., reserves the right to cancel an application or terminate employment if notified of a criminal offense that gives concern for the safety of the individuals served. I understand that Opportunities, Inc., does not discriminate in employment practices or provision of services on the basis of race, color, religion, sex, age, disability, gender, national origin, military status, genetic information or any other legally protected status. I understand that I will be required to provide proof of eligibility to work in the United States pursuant to the Immigration Reform Control Act of 1986 as a condition of employment. I understand that I am required to furnish a health card (T.B.) to Opportunities, Inc. before beginning work and annually thereafter. Employment is considered on an at-will basis and an offer of employment will not be considered a contract. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and Opportunities, Inc. reserves the same right to terminate without law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of Opportunities, Inc. is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by an officer of the Company. I understand that this application remains current for one year.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature*
Print Name*
Date*

Employment Application

High School

Additional Education

Additional Education

Additional Education

Additional Experience or Qualifications

Employment History

Previous Employment

Previous Employment

Previous Employment

Personal or Business References

Reference #1

Reference #2

Reference #3

Would you be willing to:

APPLICANT STATEMENT

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

Affirmative Action Form

Please Complete in Full