APPLICANT'S INFORMATION

How did you hear about us?

If you were referred by an existing team member at OHM, please list their name below.

First Name

Middle Name

Last Name

Other Names Used

Email

APPLICANT'S BACKGROUND

If 3 or more was selected, please explain.

If yes was selected, please explain.

If no was selected, please explain.

If yes was selected, please explain the reason for leaving.

If no was selected, please explain.

If part-time, temporary, or seasonal was selected, please explain.

EMPLOYMENT HISTORY | CURRENT OR MOST RECENT EMPLOYER

Who is your current or most recent employer?

If not employed, what is the reason that you are no longer with your most recent employer?

If currently employed, leave blank.

What was your starting pay rate with your current or most recent employer?

$

What is your current pay rate with your employer, or your final pay rate with your most recent employer?

$

Please give a brief description of the job duties involved with your current or most recent employer.

EMPLOYMENT HISTORY | SECOND MOST RECENT EMPLOYER

Who was your second most recent employer?

What is the reason that you are no longer with your second most recent employer?

What was your starting pay rate with your second most recent employer?

$

What was your final pay rate with your second most recent employer?

$

Please give a brief description of the job duties involved with your second most recent employer.

EMPLOYMENT HISTORY | THIRD MOST RECENT EMPLOYER

Who was your third most recent employer?

What is the reason that you are no longer with your third most recent employer?

What was your starting pay rate with your third most recent employer?

$

What was your final pay rate with your third most recent employer?

$

Please give a brief description of the job duties involved with your third most recent employer.

EDUCATION HISTORY

What type of study is your degree in?

What is the name of school or university where you obtained the Diploma, GED, or Degree?

QUALIFICATIONS | CERTIFICATIONS | LICENSES | SKILLS

Please list any additional qualifications, certifications, licenses, or skills that you have and would like to share with us.

If no was selected, please explain.

Please share a little bit about yourself with us.

What do you currently know about the insurance restoration industry?

Please tell us why you're interested in becoming a team member at OHM.

REFERENCES

Relationship to you

APPLICANT'S STATEMENT

Please read carefully before signing.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application as may be necessary to arrive at an employment decision. I hereby release OHM, any former employer, and any third party from all liability that may be imposed as a result of the release of such information. I hereby understand and acknowledge that any employment relationship with OHM is of an "At-Will nature, which means that the team member may resign at any time and the Company may discharge the team member at any time, with or without notice, with or without cause. It is further understood that this" At-Will" employment relationship may not be changed by any written document or by verbal agreement unless such change is specifically acknowledged in writing by the President of OHM. I hereby further agree that any dispute for any claims I may have in connection with the termination of my employment will be subject to Binding Arbitration pursuant to the roles of the American Arbitration Association.