Job Application | Opportunity Inc.

Date*

Date Format: MM slash DD slash YYYY

Personal Information

Name*

First Middle Last

Other name(s) know by:

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Do you have a valid driver's license?

State/License #

General Information About Employment Desired

Position applying for

If you are applying for the PCW - Caregiver/Lead/Manager position, one of the essential functions requires you to be able to lift 50 lbs on an ongoing daily basis, occasionally up to 75 lbs. -- Can you perform this task?

Shift

If part-time, total hours per week

Days of week you are available to work

Are you available to work nights?

Are you available to work overtime?

Are you available to be on-call?

Are you available to work holidays?

Date available to start

Salary requirements

How did you hear about us?

Are you 18 years of age or older?

Do you have a legal right to work in the United States?

Have you previously worked for Opportunity Inc.?

If Yes, when?

Do any of your relatives currently work for Opportunity Inc.?

If Yes, please list name(s) here

Background

Have you ever been convicted of a felony?

If Yes, please explain

Have you ever been convicted of a Misdemeanor: battery, endangerment, invasion of privacy, Disorderly conduct, or harassment or any other similarly related charge?

If Yes, please explain

Are there any currently pending criminal charges against you?

If Yes, please explain

NOTE: No applicant will be denied employment solely on the grounds of a conviction or a criminal offense. The nature of this offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

Education

High School

Name and location of school

Years Completed

Did You Graduate?

Subjects Studied & Degree(s) Received

Trade, Business, Correspondence School

Name and location of school

Years Completed

Did You Graduate?

Subjects Studied & Degree(s) Received

College

Name and location of school

Years Completed

Did You Graduate?

Subjects Studied & Degree(s) Received

Additional Employment Questions

Describe your experience and/or training as it relates to the position you are applying for:

Describe any licenses, certifications, awards, recognition that is relevant to the position you are applying for:

Employment History

Employer 1

Present or most recent employer

Address

Phone

Position

Duties

Average Hrs/Wk

Starting Wage

Ending Wage

Start Date

mm/dd/yyyy

End Date

mm/dd/yyyy

Reason for leaving

Supervisor Name

Title

May we contact this person?

Employer 2

Address

Phone

Position

Duties

Average Hrs/Wk

Starting Wage

Ending Wage

Start Date

mm/dd/yyyy

End Date

mm/dd/yyyy

Reason for leaving

Supervisor Name

Title

Employer 3

Address

Phone

Position

Duties

Average Hrs/Wk

Starting Wage

Ending Wage

Start Date

mm/dd/yyyy

End Date

mm/dd/yyyy

Reason for leaving

Supervisor Name

Title

Employer 4

Address

Phone

Position

Duties

Average Hrs/Wk

Starting Wage

Ending Wage

Start Date

mm/dd/yyyy

End Date

mm/dd/yyyy

Reason for leaving

Supervisor Name

Title

Professional References

Name

Relationship

Years Known

Phone

Name

Relationship

Years Known

Phone

Name

Relationship

Years Known

Phone

Name

Relationship

Years Known

Phone

Reference Check Authorization

Please read and initial the fields below. If there is any part of this page you do not understand, please ask the interviewer about it before signing the bottom.

I HEREBY CERTIFY that the answers given by me to the above questions and statements are true and correct and hereby authorize Opportunity Inc. to contact references, past or present employers, persons, schools, law enforcement agencies and any other sources of information which may be relevant to my application for employment. I further authorize my current and former employers to disclose to the company any and all letters, reports and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release Opportunity, Inc., my current and former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.

Please initial

I understand that if offered employment, the offer is contingent on my passing a post-offer drug screen, TB test, and physical. By signing this application, I voluntarily agree to submit to the post-offer screens. I understand that failure to pass the post-offer screens will result in withdrawal of the employment offer.

Please initial

I understand that if offered employment, the offer is contingent on my passing a post-offer drug screen, TB test, and physical. By signing this application, I voluntarily agree to submit to the post-offer screens. I understand that failure to pass the post-offer screens will result in withdrawal of the employment offer.

Please initial

If employed by Opportunity Inc., I agree to abide by all of the work and safety rules of the Company. If employed, I also agree to submit to drug testing as a condition of employment. I agree that Opportunity Inc. may conduct alcohol or drug screening at their sole discretions with or without notice. I also understand that refusal to submit to an alcohol/drug screen will be considered a voluntary resignation of employment. Also, if employed, I realize that the Companies may conduct post-accident, reasonable suspicion, periodic and/or random drug, and/or alcohol testing of its employees. I have read, understand, and agree to the above statement.

Please initial

I understand that nothing contained in the application or conveyed to me during any interview, which may be granted, is intended to create an employment contract, implied or explicit, between Opportunity Inc. and me. In addition, I understand and agree that if I am employed my employment relationship with Opportunity is strictly voluntary and at our mutual will. I understand that if I am employed, my employment is for no definite period and may be terminated at any time, with or without prior notice, with or without cause or reason, at the option of either myself or Opportunity Inc., and that no promises or representations contrary to the forgoing are binding on Opportunity Inc. unless made in writing and signed jointly by the Board of Directors and myself.

Please initial

I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or benefits, policies, and procedures will not alter our at-will agreements.

Please initial

I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States on my first day of employment.

Please initial

If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid Wisconsin driver’s license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by Opportunity’s auto insurance, if required for my position.

Please initial

It is understood and agreed that any misrepresentation, false statement, or omissions by me in the Application will be sufficient reason for rejection of my application or for dismissal at any time during my employment, without liability to Opportunity. This includes furnishing a false name or social security number. I have read, understand, and agree to the above statement.

Please initial

I further understand that no representative of Opportunity have the authority to enter into any agreement for employment for any specified period of time and that these companies are not guaranteeing employment for anyone. No employment contract is created by virtue of my being hired by these companies, and, if hired, my employment will be at will and may be terminated at any time without prior notice. I have read, understand, and agree to the above statement.

Please initial

I understand that this application will remain on the file for 60 days for consideration. After 60 days, if I am still interested in a position with this Company, it will be necessary for me to complete a new application form.

Please initial

Name

First Middle Last

Signature

Date

Do you accept the terms and conditions stated above?

By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.

Documents

Resume

Cover Letter

Voluntary Self-Identification

Confidential - For Statistical Use Only

We are an Equal Opportunity Employer and do not discriminate on the basis of race, color, religion, sex age, national origin, disability, veteran status, sexual orientation or any other classification protected by Federal, state, or local law. The information below will be used only in the compilation of data for Equal Employment Opportunity reporting.

Completion of this data is voluntary and will not affect your opportunity for employment, or terms or conditions of employment, if hired. Identification can be declared at any time prior to, or if applicable, after hire. Please return this page with application.

Today's Date

Position Applied For

Name

First Middle Last

Social Security #

Sex

Date of Birth

Applicant's Zip Code

Ethnic Group:
(Please check one of the descriptions below corresponding to the ethnic group with which you most identify.)

American Indian or Alaskan Native

A person having origins in any of the original people of North American and South America (Including Central America), and who maintains tribal affiliation or community attachment.

Asian

A person having origins in any of the original peoples of the East, Southeast Asia, or the Indian subcontinent Including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American

A person having origins in any of the Black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or African American.”

Native Hawaiian or Other Islander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White

A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Hispanic or Latino (All Races)

A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture of origin, regardless of race.

Hispanic or Latino (White Races Only)

A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of the White race.

Hispanic or Latino (All Other Races)

A person of Mexican, Puerto Rican, Cuban, Central of South American, or other Spanish culture or origin, and of any race other than White.

Race Missing or Unknown

Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification and no further contact is made with the applicant.

Veteran Status:
(Please check one if it describes your veteran status)

Special Disabled Veteran

Means (a) a veteran who is entitled to compensation (or who, but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veteran Affairs for a disability rated at 10 or 20 percent in the case of a veteran who has been determined to have a serious employment disability or (b) a person who was discharged or released from active duty because of a service-connected disability.

Vietnam Era Veteran

Means (a) veteran, any part of whose active military, naval, or air service, was during the period August 5, 1964 through May 7, 1975 who (a) served on active duty for a period of more than 180 days and was discharged or released there from with other than a dishonorable discharge, or (b) was discharged or released from active duty because of a service-connected disability. No veteran can be considered to a veteran of the Vietnam era under this paragraph after Dec. 31, 1994.

* Veteran status may be requested only after offer is made.

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Personal Information

General Information About Employment Desired

Background

Education

Additional Employment Questions

Employment History

Professional References

Reference Check Authorization

Documents

Voluntary Self-Identification

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