General Employment Application - E3 OMI

It is the policy of E3 OMI to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicant Information

Applicant Name*

First Last

Address*

Street Address City State ZIP Code

Mobile Phone*

Home Phone*

Position Details

Job Position Applying For*

Salary Desired*

Who referred you to our company?

Are you at least 18 years old?*

Yes
No

If applicable, are you available to work overtime?*

Yes
No

If you are offered employment, when would you be available to begin work?*

Are you legally eligible for employment in the United States?*

Yes
No

Are you able to perform the essential functions of the job position with or without reasonable accommodation?*

Yes
No

What reasonable accommodation, if any, would you require?*

Have you ever been convicted of any crime, including traffic violations?*

Yes
No

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Explain

Applicant Employment History

List you current or most recent employment first.

How many previous employers do you want to list?*

Previous Employer 1

Employer Name*

Address*

Street Address City State ZIP Code

Job Duties*

Reason for Leaving*

Date Employment Started*

Date Employment Ended*

Previous Employer 2

Employer Name*

Address*

Street Address City State ZIP Code

Job Duties*

Reason for Leaving*

Date Employment Started*

Date Employment Ended*

Previous Employer 3

Employer Name*

Address*

Street Address City State ZIP Code

Job Duties*

Reason for Leaving*

Date Employment Started*

Date Employment Ended*

Applicant's Education and Training

College / University Name

Address

Street Address City State ZIP Code

Did you receive a degree?

Yes
No

Degree Received

High School / GED Name

Address

Street Address City State ZIP Code

Did you receive a degree?*

Yes
No

Other Training

Graduate, Technical, Vocational

Awards, Honors, Special Achievements

Military Service*

Yes
No

Branch*

Specialized Training*

References

List any two people who would be willing to provide a reference for you.

Name*

First Last

Address*

Street Address City State ZIP Code

Phone

Name*

First Last

Address*

Street Address City State ZIP Code

Phone

Please provide any other information that you believe should be considered.

To be read and signed by applicant

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize E3 OMI, LLC., to contact former employers and educational organizations regarding my employment and education.

I authorize my former employers and education organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Manager, the employment relationship will be “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reason of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Enhanced E3 OMI, LLC., except in a specific written contract of employment signed on behalf of the organization by its Manager, has the power to alter or vary the voluntary nature of employment relationship.

Acknowledgment*

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Date*

Applicant Signature*

First Last

Phone

This field is for validation purposes and should be left unchanged.