OREMC Employment Application

Employment Application

We are an Equal Opportunity Employer Committed to Excellence through Diversity

The application must be fully completed to be considered. Please complete each section even if you attach a resume.

Name

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip

Phone Number

Please enter a valid phone number.

Mobile Number

Email Address

Are You a U.S Citizen

YesNo

Have You Ever Been Convicted Of A Felony?

YesNo

If Yes, Explain*

If Selected For Employment Are You Willing To Submit to a Pre-Employment Drug Screening Test and Physical Exam?

YesNo

To the best of your knowledge, are you related by “blood” or marriage to the immediate family of any present OREMC employee or director? If yes, please explain:

YesNo

Name

Relationship

Position You Are Applying For

Available Start Date

Date

Desired Pay

Employment Desired

Full TimePart TimeSeasonal/Temporary

School Name (1)

Location

Degree Received

Major

Years Attended

School Name (2)

Location

Degree Received

Major

Years Attended

School Name (3)

Location

Degree Received

Major

Years Attended

Name (1)

Address

Phone Number

Please enter a valid phone number.

Relationship

Name (2)

Address

Phone Number

Please enter a valid phone number.

Relationship

Name (3)

Address

Phone Number

Please enter a valid phone number.

Relationship

Employer (1)

Job Title

Starting Pay Rate

Ending Pay Rate

Phone Number

Please enter a valid phone number.

Dates Employed

From

To

Address

Street Address Line 2

CityState

Zip

Employer (2)

Job Title

Starting Pay Rate

Ending Pay Rate

Phone Number

Please enter a valid phone number.

Dates Employed

From

To

Address

Street Address Line 2

CityState

Zip

Employer (3)

Job Title

Starting Pay Rate

Ending Pay Rate

Phone Number

Please enter a valid phone number.

Dates Employed

From

To

Address

Street Address Line 2

CityState

Zip

Please upload your resume and any certificates here:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Date

I hereby authorize OREMC to investigate all statements contained in this application. I understand that misrepresentation or omission of material facts will be a cause for immediate dismissal without notice. I understand that if offered a position with OREMC, the offer will be conditioned upon the passing of all required screenings and medical exams as related to the requirements of the job. I certify, as a condition of my employment that all information given on this application is correct, that I will comply with all the rules and regulations of this corporation that are in effect now and any others that may be instituted at a later date. I also agree to follow all health and safety regulations including the use of safety equipment at all times on the job. I also authorize with regard to my character, ability, employment habits and agree to hold any persons contacted harmless with respect to any information they may give. I understand that my employment is conditioned also upon the results of the urine drug screen for which I submitted or will submit a specimen for testing. I realize that any positive result not caused by the presence of legitimately prescribed prescription drugs will cause my being refused employment.

Date

Name (Please Print)

Signature

Education

References

Employment History