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EMPLOYMENT APPLICATION

Candidate Information

First name*

Middle Name*

Last name*

Birthday*

Month

Day

Year

Email*

Phone Number*

Please use this format: (123-456-7890)

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Driver’s License #

State & Exp. Date

Position Applied for:*

Are you authorized to work in the U.S.?*

Yes

Do you have a smartphone?*

Yes

Note: Omega requires use of an attendance app.

Have you ever been convicted of a crime? *

Yes

If yes, explain below:

Have you ever applied for employment with Omega?*

Yes

If yes, when?

Have you ever worked for Omega? *

Yes

If yes, when?

Do you know any current or former Omega employee?*

Yes

If yes, who?

For the purposes of eligibility to drive an Omega vehicle, have you had any moving violations in the past 36 months? *

Yes

Note: Employees under the age of 25 may not be assigned to sites where driving Omega vehicles is required.

Do you have access to a reliable vehicle to transport yourself to and from work?*

Yes

Note: Not a disqualifier, but may limit to what sites you may be assigned.

List valid certifications, such as RAMP, Act 235, CPR, EMT, etc.

Availability

Please check all boxes for the days and times that you are available and willing to work:

Sunday*

Daytime

Afternoon

Evening

Overnight

No Availability

Monday*

Daytime

Afternoon

Evening

Overnight

No Availability

Tuesday*

Daytime

Afternoon

Evening

Overnight

No Availability

Wednesday*

Daytime

Afternoon

Evening

Overnight

No Availability

Thursday

Daytime

Afternoon

Evening

Overnight

No Availability

Other

Friday*

Daytime

Afternoon

Evening

Overnight

No Availability

Saturday*

Daytime

Afternoon

Evening

Overnight

No Availability

Education

High School

City & State

Start Year & End Year

Did you graduate?

Yes

College / Other

City & State

Start Year & End Year

Did you graduate?

Yes

Degree:

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain:

Employment History

Company

Phone

Address

Job Title

Supervisor

Start Date

End Date

Reason for Leaving

Company

Phone

Address

Job Title

Supervisor

Start Date

End Date

Reason for Leaving

Have you ever been terminated or asked to resign from a position?*

Yes

If yes, explain:

If you would like to attach your resume:

Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize Omega to conduct background checks and consent to a random drug and/or alcohol screening requirement.

I understand that I am required to undergo the finger printing process, complete the Northampton County Private Detective Employee Statement form, and present documents as needed to complete the I-9 Employment Eligibility Verification form such as a valid driver’s license, Social Security card, passport, or other legal form of identification.

Omega does not discriminate on account of race, color, religion or creed, national origin or ancestry, sex, sexual orientation, age, physical or mental disability, veteran status, genetic information, or citizenship.

Signature*

Signature field is empty.

Date

Month

Day

Year

Call: 610-262-7621

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