_Test Application | Opportunity Homes, Inc

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, martial or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.

Applicants need to have a high school diploma, GED, or equivalent and a valid driver’s license.

PERSONAL INFORMATION

First Name *

Last Name *

Address *

(Number/Street/City/State/Zip)

Phone *

Best time to call *

Email *

Referred by *

Walk-in
Ad
School
Iowa Workforce Development
Other
Employee

You selected other, please explain. *

You selected employee, enter name of employee. *

Date available to work *

Position applying for

Skills Trainer

Are you available to work

Full-time
Part-time
Temporary

You selected full-time, please indicate shift preference(s). *

Afternoon/Evenings
Overnight

You selected part-time, how many hours per week are you available to work? *

You selected temporary, please select a start and end date. *

Are you currently on lay-off status and subject to recall? *

Have you ever filed an application with us before? *

You selected yes. Please let us know when you applied. *

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. *

Have you been convicted of a felony with the last 7 years? (No applicant will be denied employment solely on the grounds of a conviction or pending criminal charge. The nature of the offense, the date, the surrounding circumstances, and relevance to the position applied for will be considered.)

You selected yes, please explain. *

Have you been convicted of Medicaid fraud? *

Do you have a record of founded child or dependent adult abuse or have you ever been convicted of crime in this state or any other state? *

EMPLOYMENT REFERENCES

*Note: Providing accurate fax numbers will expedite the reference check process.

Employer #1 (Current/most recent) *

Start Date *

End Date *

Supervisor’s Name *

May we contact? *

Employer’s Address *

Phone *

Fax *

Position *

Starting Wage *

Final Wage *

Reason for Leaving *

Duties *

Employer #2 (previous)

Start Date

End Date

Supervisor’s Name

May we contact?

Employer’s Address

Phone

Fax

Position

Starting Wage

Final Wage

Reason for Leaving

Duties

Employer #3 (previous)

Start Date

End Date

Supervisor’s Name

May we contact?

Employer’s Address

Phone

Fax

Position

Starting Wage

Final Wage

Reason for Leaving

Duties

PERSONAL REFERENCES

PERSONAL REFERENCE NAME #1: *

Address: *

Phone #: *

Relationship: *

Years Known: *

PERSONAL REFERENCE NAME #2: *

Address: *

Phone #: *

Relationship: *

Years Known: *

PERSONAL REFERENCE NAME #3: *

Address: *

Phone #: *

Relationship: *

Years Known: *

EDUCATION

School Name *

Location *

Course of Study *

Number of Years *

Did you graduate? *

School Name

Location

Course of Study

Number of Years

Did you graduate?

OTHER EXPERIENCE

Please describe other life experiences which may pertain to the position for which you are applying (i.e. volunteer work, other training, special skills, etc.) *

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

APPLICANT’S STATEMENT

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 45 days. Any applicant wishing to be considered for employment beyond this period should inquire as to whether or not applications are being accepted at that time.

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.

Agreement *

By checking this box, I (the applicant stated above), do hereby authorize the release of information obtained from current/previous employer(s) to Opportunity Homes, Inc. and relieve any individual and/or company completing a reference check of all legal responsibilities.

First Name *

Last Name *

Date *

AUTHORIZATION FOR RELEASE OF INFORMATION

I authorize Opportunity Homes, Inc. to contact my current and/or former employers, educational institutions I have attended, or other persons with whom I have acquaintance.

I am aware that Opportunity Homes, Inc. will conduct a records check for criminal child and dependent adult abuse in this and other states.

Agreement *

By checking this box, I certify that I agree with and understand the two statements listed above.

First Name *

Last Name *

Date *

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT REFERENCES

PERSONAL REFERENCES

EDUCATION

OTHER EXPERIENCE

APPLICANT’S STATEMENT

AUTHORIZATION FOR RELEASE OF INFORMATION