Job Application Page

Name

First

Middle

Last

Email

Street Address

City

State

Zip Code

Phone Number:

Format: (xxx)-xxx-xxxx

Social Security Number:

Position(s) Applied For:

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes
No
Over 18

Have you ever filed an application with us before?

Yes
No

If yes, give date:

Format: MM-DD-YYYY

Have you ever been employed with us before?

Yes
No

If yes, give date:

Format: MM-DD-YYYY

Are you currently employed?

Yes
No

May we contact your present employer?

Yes
No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.

Yes
No

On what date would you be available for work?

Format: MM-DD-YYYY

Are you available to work:

Full Time
Part Time
Shift Time
Temporary

Are you current on “Lay-off” status and subject to recall?

Yes
No

Can you travel if a job requires it?

Yes
No

Have you been convicted of a felony within the last 7 years?

Yes
No

Conviction will not necessarily disqualify an applicant from employment

If yes, please explain:

If convicted of a felony in last 7 years, please enter explanation of situation.

Gender:

Male
Female
I choose not to provide this information

All qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, citizenship, disability, or veteran status. Additionally, Dave O’Mara Contractor, Inc. provides reasonable accommodation to qualified individuals with disabilities. Government regulations require Dave O’Mara Contractor, Inc. to annually report upon the ethnicity, race and gender of its employees. To assist Dave O’Mara Contractor, Inc. to comply with these government regulations and reporting requirements, we request that you identify your ethnicity, race and gender below. Submission of this information is voluntary. You will not be subjected to any adverse treatment if you do not provide the information requested. This data will be kept in a separate file from your Application for Employment.

Race:

White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black or African American – A person having origins in any of the Black racial groups of Africa.
Hispanic or Latino – A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin.
Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaskan Native – A person having origins in any original peoples of North America, and who maintain cultural identification through tribal affiliations or community recognition.
Native Hawaiian or other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Two or More Races
I choose not to provide this information

All qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, citizenship, disability, or veteran status. Additionally, Dave O’Mara Contractor, Inc. provides reasonable accommodation to qualified individuals with disabilities. Government regulations require Dave O’Mara Contractor, Inc. to annually report upon the ethnicity, race and gender of its employees. To assist Dave O’Mara Contractor, Inc. to comply with these government regulations and reporting requirements, we request that you identify your ethnicity, race and gender below. Submission of this information is voluntary. You will not be subjected to any adverse treatment if you do not provide the information requested. This data will be kept in a separate file from your Application for Employment.

Applicant Survey of Veteran Status

Veteran Status 2

If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.

I identify as one of more of the classifications of protected veteran listed above
I am not a protected veteran
I choose not to provide this information

Submission of Veteran Status information is voluntary. You will not be subjected to any adverse treatment if you do not provide the information requested. This data will be kept in a separate file from your Application for Employment.

Voluntary Self-Identification of Disability

Voluntary Disability Disclosure

may work? and

How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:

All qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, citizenship, disability, or veteran status. Additionally, Dave O’Mara Contractor, Inc. provides reasonable accommodation to qualified individuals with disabilities. Government regulations require Dave O’Mara Contractor, Inc. to annually report upon the ethnicity, race and gender of its employees. To assist Dave O’Mara Contractor, Inc. to comply with these government regulations and reporting requirements, we request that you identify your ethnicity, race and gender below. Submission of this information is voluntary. You will not be subjected to any adverse treatment if you do not provide the information requested. This data will be kept in a separate file from your Application for Employment.

Education – Please list all relevant information, such as the school's name, address, course of study, years completed, and degree achieved for each school.

Education – High School

Education 2

Education – Undergraduate College

Education 3

Education – Graduate Professional

Education 4

Education – Other (Specify)

Indicate any foreign languages you can speak, read and or write

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

Describe any job-related training received in the United States military.

Other Qualifications – Summarize special job-related skills, Production Machinery, Operator Skills, Office or Organizational Skills:

Employment Experience:

Employer Business Name:

Employer Telephone:

Employer Address:

Job Title:

Supervisor:

Dates Employed:

Start Date (MM/DD/YYYY) to End Date (MM/DD/YYYY)

Hourly Rate/Salary:

Enter Final Rate

Reason for Leaving?

Employment Experience: (2nd Entry)

Employer Business Name: (2nd Entry)

Employer Telephone: (2nd Entry)

Employer Address: (2nd Entry)

Job Title: (2nd Entry)

Supervisor: (2nd Entry)

Dates Employed: (2nd Entry)

Start Date (MM/DD/YYYY) to End Date (MM/DD/YYYY)

Hourly Rate/Salary: (2nd Entry)

Enter Final Rate

State any additional information you feel may be helpful to us in considering your application.

References:

Reference 1 – Name and Phone Number

References 2

Reference 2 – Name and Phone Number

References 3

Reference 3 – Name and Phone Number

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 365 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Accept