Application for Employment

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT.

This application is merely intended to provide information necessary to evaluate suitability for employment. It is the policy of Osage Industries, Inc. to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state or federal law. It is also the policy of Osage Industries, Inc. to conduct pre-employment screening before a job offer is made. If a job offer is made, employment will be contingent upon the successful completion of background and drug testing. This application will remain active for 180 days.

Personal Information

First Name*

Last Name*

Middle

Phone Number*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Education

High School

School name*

Location (City, State)*

Did you earn a diploma or GED?*

Do you want to add a College or Grad School

College or Grad School

School name

Location (City, State)

Degree

Do you want to add a Trade School

Trade School

School name

Location (City, State)

Degree or area of study

Employment History

Most Recent Employer

Company*

Supervisor

May we contact this employer?

Phone Number

Location (City, State)*

Position Held*

Start Date*

End Date

Pay Rate Upon Leaving

Duties*

Reason for Leaving*

Do you have a second employer to add?*

Second Most Recent Employer

Company

Supervisor

May we contact this employer?

Phone Number

Location (City, State)

Position Held

Start Date

End Date

Pay Rate Upon Leaving

Duties

Reason for Leaving

Do you have a third employer to add?*

Third Most Recent Employer

Company

Supervisor

May we contact this employer?

Phone Number

Location (City, State)

Position Held

Start Date

End Date

Pay Rate Upon Leaving

Duties

Reason for Leaving

Employment Eligibility

Position Information

How did you hear about us?

Position applied for*

Date you can begin work*

Desired annual salary or hourly rate

Do you certify you have received and reviewed the job description and that you are able to perform the functions of the position you are applying for either with or without reasonable accommodation?*

Please list any special skills, certifications, or licenses you have that relate to the position.

Background Information

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

Have you ever been arrested for, charged with, or convicted of any crime? If yes, please explain.*

Comments

Do you have a valid driver’s license?*

Have you ever had your drivers’ license suspended or revoked, or had your driving privileges modified by a court of law?*

Have you been arrested for, charged with, or convicted of any driving offenses in the past five years?*

Please list all states from which you hold or have held a driver’s license.*

References (Other than relatives)

Name*

Email

Phone*

Name*

Email

Phone*

Name*

Email

Phone*

Resume

Resume Upload

If you have a resume, please upload it here. We allow file extensions of .docx, .doc, and .pdf.

Accepted file types: docx, doc, pdf, Max. file size: 8 MB.

Application Certification

Do you agree to the following conditions?

I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release Osage Industries, Inc. from all liability that might result from making the investigation.
If I am offered and accept a position, I agree to conform to all existing and future Osage Industries, Inc. rules and regulations and I understand that Osage Industries, Inc. reserves the right to change wages, hours, and working conditions as deemed necessary.
I understand that, if hired, my employment will be at-will, meaning that either party can end the employment relationship at any time and for any or no reason.
I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

By checking this box, you agree to all the above conditions of the Application Certification.*

I agree.

Digital Signature*

Place the cursor within the box. Click and hold with your mouse while providing your signature. Use the refresh button in the bottom right corner if you need to try again.

Date Signed*

Email

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

Job Application

Application for Employment

Personal Information

Education

High School

College or Grad School

Trade School

Employment History

Most Recent Employer

Second Most Recent Employer

Third Most Recent Employer

Employment Eligibility

Position Information

Background Information

References (Other than relatives)

Resume

Application Certification

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