Oar Staffing Employment Application
Thank you for your interest in working with Oar Staffing. Please complete the employment application and we will get back to your shortly.
Name
*
First Name
Last Name
Preferred Oar Staffing Location:
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Medical - VA
Medical - NC
York, PA
Atlanta
Philadelphia
Freehold, NJ
Reno
Phoenix
Cincinnati
Pittsburgh, PA
Baltimore
Northern Virginia
Washington, DC
Other
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
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Date Of Birth
*
-
Month
-
Day
Year
Position Applying For
*
Do you the legal right to work in the United States
*
Yes
No
OAR STAFFING, INC AND ITS SERVICE PROVIDERS OFFER EQUAL EMPLOYMENT OPPORTUNITIES REGARDLESS OF SEX, AGE, RACE, COLOR, RELIGIOUS CREED, NATIONAL ORIGIN, ANCESTRY, MEDICAL STATUS, MEDICAL CONDITION, PHYSICAL OR MENTAL DISABILITY, PREGNANCY OR SEXUAL ORIENTATION.
LICENSE/CERTIFICATIONS
Are you Licensed/Certified?
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Yes
No
Name of License/Certification and issuing state
License/Certification Number
Has your Licensed/Certification ever been revoked or suspended?
Yes
No
If yes, state reasons, date of revocation or suspension and date of reinstatement
Emergency Contacts
Emergency Contact
*
First Name
Last Name
Email
*
Phone Number
*
Emergency Contact
*
First Name
Last Name
Email
*
Phone Number
*
Employment History
CURRENT OR LAST EMPLOYER
*
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Your title
*
Description of your duties/work
*
May we contact your Supervisor?
*
Yes
No
Name of Supervisor
Supervisor Title
Supervisor Phone Number
PREVIOUS EMPLOYER
Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Your title
Description of your duties/work
May we contact your Supervisor?
Yes
No
Name of Supervisor
Supervisor Title
Supervisor Phone Number
REFERENCES NAMES OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR
Reference
*
Reference Phone Number
*
Reference
*
Reference Phone Number
*
Reference
*
Reference Phone Number
*
PLEASE REVIEW THE FOLLOWING BEFORE SIGNING THIS APPLICATION FOR EMPLOYMENT
I AUTHORIZE ANY REPRESENTATIVE OF OAR STAFFING, INC OR ITS SERVICE PROVIDERS TO INVESTIAGTE MY BACKGROUND, INCLUDING BUT NOT LIMITED TO, REFERENCE, EDUCATION AND WORK HISTORY I AUTHORIZE THE ABOVE AND ANY OTHER INDIVIDUAL OR ENTITY THAT POSSES INFORMATION ABOUT MY BACKGROUND TO PROVIDE FULL DISCLOSURE WITHOUT PRIOR NOTICE TO ME I RELEASE ALL OF THE ABOVE FROM ANY AND ALL LIABILITY FOR DAMAGE OF ANY KIND WHICH MAY AT ANY TIME RESULT TO ME BECAUSE OF COMPLIANCE WITH THIS AUTHORIZATION TO RELEASE INFORMATION.
*
YES
NO
I UNDERSTAND THAT ANY FALSIFICATION OF THIS OR ANY OAR STAFFING INC, OR IT SERVICE PROVIDERS DOCUMENTS MAY RESULT IN FAILURE TO RECEIVE AN OFFER OR IF HIRED, DISCISSAL FROM EMPLOYMENT
*
YES
NO
I UNDERSTAND THAT ANY OFFER MAY BE CONDITIONAL ON A SUCCESSFUL COMPLETION OF MEDICAL, BACKGROUND AND OR DRUG TESTING
*
YES
NO
If assigned, can you provide written evidence that you are authorized to work in the United States?
*
Yes
No
Are you eligible to perform the essential functions of the position for which you are applying either with or without reasonable accommodations?
*
Yes
No
If necessary please describe what types of reasonable accommodations are needed.
ACKNOWLEDGEMENT FOR WORKERS COMPENSATION PROCEDURES
Report promptly all work - related injuries to your supervisor. Your Oar Staffing Staffing supervisor will direct you to the nearest authorized Occupational Medial Provider.
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I AGREE AND UNDERSTAND
If it is a medical emergency, get medical care immediately, then notify your Oar Staffing supervisor.
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I AGREE AND UNDERSTAND
Complete a Worker Compensation packet within 24 hours of the time of injury, including the Injury Incident Report and Post - Accident Drug Testing Policy.
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I AGREE AND UNDERSTAND
Take post injury drug screen at the clinic.
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I AGREE AND UNDERSTAND
After treatment, you must bring back to your supervisor the paperwork given to you at the clinic. This will normally include the Doctor's report with any Work Restrictions and Documentation that you did take a Drug Test. Understand that in almost every case "Modified Work Will be Offered to You"
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I AGREE AND UNDERSTAND
Your name
*
Signature
*
Todays Date
-
Month
-
Day
Year
Date
How did you find out about Oar Staffing?
*
Submit
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