Job Application Date MM slash DD slash YYYY Position(s) you are applying for: Date you can start: PERSONAL INFORMATIONLast Name: First Name: Middle Initial: Other Names Used: Present Address: Present Address: City: State: Zip Code: Mailing Address: Email Address: City: State: Zip Code: Home Phone:Alternate Phone Number:Driver’s License Number / Expiration Date: Auto Insurance Carrier / Policy Number: Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No If no, describe the functions that cannot be performed. (NOTE: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.) Yes No Do you have a reliable means of transportation to and from work? Yes No Do you have automobile insurance as required by California Law? Yes No (A dependable vehicle must be available for conducting company business) (If employment is offered, you are required to maintain automobile insurance as required by California law.) EDUCATIONName of School and AddressHigh School Vocational / Business Other Special Studies/ Abilities Graduated (Yes/No)High School College Vocational / Business Other Special Studies/ Abilities Number of Years CompletedHigh School College Vocational / Business Special Studies/ Abilities Course or Major High School College Vocational / Business Other Special Studies/ Abilities GENERAL INFORMATIONHave you ever applied to or worked for this Company before? Yes No If yes, please specify dates: EMPLOYMENT / WORK EXPERIENCEList all present and past employment starting with your most recent employer (last 5 years is sufficient). Please include a list of work performed on a voluntary basis. If additional pages are needed, please attach Name of Company: Address: Telephone Number:Dates of employment: From To Average number of hours worked per week: Position(s) held: Supervisor’s name and position: Describe your duties: May we contact this employer? Yes No Reason for leaving: Name of Company: Address: Telephone Number:Dates of employment: From To Average number of hours worked per week: Position(s) held: Supervisor’s name and position: Describe your duties: May we contact this employer? Yes No Reason for leaving: Name of Company: Address: Telephone Number:Dates of employment: From To Average number of hours worked per week: Position(s) held: Supervisor’s name and position: Describe your duties: May we contact this employer? Yes No Reason for leaving: Identify and explain all periods of unemployment during the last five years:From To Reason for Unemployment REFERENCESList three persons not related or living with you who have knowledge of your work performance within the last three years. Name Address Phone number No. of years acquainted Occupation I hereby certify that I have not knowingly withheld any information that might adversely affect my Initials chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize OpenDoor Services Inc. to thoroughly investigate my references, work record, Initials education and other matters related to my suitability for employment. I understand that nothing contained in the application or conveyed during any interview which Initials may be granted or during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company’s designated representative. I understand ODS participates in the DMV Employer Pull Notice Program. Each employee Initials is obligated to sign a release to authorize ODS to obtain the employee’s current driving record. I understand this is part of the annual evaluation process to ensure my driving record meets DDS/California State licensing requirements. I understand, as a condition of hiring, I must successfully pass a pre-employment drug screen; Initials and a State required fingerprint background search and TB testing. Should a search of public records (including records documenting an arrest, indictment, Initials conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired because of such information, I am entitled to a copy of any such records even though I have checked the box below. I waive receipt of a copy of any public record described in the paragraph above. I also understand that all offers of employment are conditioned on: satisfactory evidence of my U.S. citizenship or proof of legal right to live and work in this country; satisfactory completion and passing pre-employment functional capabilities standard physical and drug test; having a satisfactory driving record that meets or exceeds company policy; having a safe/reliable vehicle with valid automobile insurance as required by California law; and meeting the California Community Care Licensing personnel standards. Applicants Signature Date MM slash DD slash YYYY OpenDoor Services, Inc. is an equal opportunity employer. The Company does not discriminate based on age, race, color, religion, sex, national origin, political affiliation, disability, handicap, marital status, or any other characteristic protected by applicable state or federal civil rights.
