Phone: (309) 827-0377

Employment Application

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Maximum upload size: 67.11MB

Personal Information

Last
First
Middle

Education

School & Location
Degree Earned
Course of study/major
Years Completed
Did you graduate?
School & Location
Degree Earned
Course of study/major
Years Completed
Did you graduate?
School & Location
Degree Earned
Course of study/major
Years Completed
Did you graduate?
School & Location
Degree Earned
Course of study/major
Years Completed
Did you graduate?

Disclosures


Please note: Driver’s license suspensions/revocations do not automatically reject an applicant.

Employment History

Past 10 years, most recent employer first
please include area code
Per

please include area code
Per

please include area code
Per

Professional References

Please list three people, not related to you, who can provide information as to your experience, training, skills, and/or character. (Examples: Employers, supervisors, teachers, mentors, or co-workers.)

Why

Signature

Certification of Information: I hereby certify that the information contained in this application is correct to the best of my knowledge and understand that deliberate falsification of this information may be grounds for dismissal.

Authorization for Release of Information

I hereby authorize Project Oz to obtain and verify verbally or in writing such information about my background and qualifications for employment at Project Oz, in its sole discretion, deems relevant to its decision whether to hire me for the position I am applying for, including without limitation professional and personal references, employment verifications, educational verifications, license and credentials verifications, criminal records, motor vehicle records, and Social Security number verifications.

In regards to Project Oz considering my application for employment, I hereby release Project Oz and its officers, directors, agents, and employees from any and all claims I may have arising out of the obtaining and verification of such information.

I hereby authorize any and all persons to disclose information to Project Oz about my previous employment or suitability for future employment.

In consideration of any person agreeing to provide information to Project Oz as authorized by this form, I hereby release any such person and any affiliated officers, directors, agents, and employees from any and all claims I may have arising out of the disclosure of such information.

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