Opportunities Unlimited - OU Application Form

Employment History

List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities. If you have less than 5 years of employment, include personal references to be contacted.
May we contact your current employer? *

Yes No
Most Recent Employer
Most Recent Employer
Most Recent Employer Address
Phone Number

- Area Code Phone Number
Position/Supervisor
Wage
From/To Date Employed *
Major Duties
Reason for Leaving
Second Employer

Check to enter employer information
Employer 2
Employer Name
Employer Address
Phone Number

- Area Code Phone Number
Position/Supervisor
Wage
From/To Date Employed *
Major Duties
Reason for Leaving
Third Employer

Check to enter employer information
Employer 3
Employer Name
Employer Address
Phone Number

- Area Code Phone Number
Position/Supervisor
Wage
From/To Date Employed *
Major Duties
Reason for Leaving
Fourth Employer

Check to enter employer information
Employer 4
Employer Name
Employer Address
Phone Number

- Area Code Phone Number
Position/Supervisor
Wage
From/To Date Employed *
Major Duties
Reason for Leaving
Fifth Employer

Check to enter employer information
Employer 5
Employer Name
Employer Address
Phone Number

- Area Code Phone Number
Position/Supervisor
Wage
From/To Date Employed *
Major Duties
Reason for Leaving
Other Employers

If you have more than five employers, please select the checkbox below and enter their information.
More than five employers

Please check here if you have more than 5 employers
Additional Employers
Special Skills
As they relate to position applied for.
Emergency Contact Information
Name: *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Relationship to you *

Please Read This Statement Carefully
I certify that all information I have provide in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, and its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawful discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant form consideration for employment on any basis prohibited by applicable local, state, and federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by 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 the employer 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 the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (1) eliminate me from further consideration for employment, or (2) may result in my immediate discharge from the employer’s service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.
Applicant Statement Electronic Signature *
Date *

- Month - Day Year