Opportunity House, Inc.
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application for employment
An Equal Opportunity House Employer That Offers A Drug Free Workplace
It is our policy to comply with all applicable laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classes, in all our employment practices, and to hire only U.S. Citizens or aliens lawfully authorized to work in the United States.
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Indicates required field
Last Name
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First Name
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Middle Name
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Date
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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Are you 18 years or Older?
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Yes
No
Are you a U.S. Citizen or otherwise authorized to work in the U.S. on an unrestricted basis?
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Yes
No
Are there any hours, shifts, or days that you cannot or will not work?
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Yes
No
If yes, please explain:
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Do you want full-time or part-time work?
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Full-time
Part-time
If part-time, explain in detail why:
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Wage or Salary desired?
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If hired, when would you be available to start work?
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Are you bilingual?
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Yes
No
Language:
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How did you hear about us?
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If a current Opportunity House staff person referred you, please indicate their name:
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If necessary for the position, do you have a vehicle which can be used for business travel?
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Yes
No
IMPORTANT:
If you are hired, we will do a motor vehicle driving record check and criminal record background check.
Do you have a valid Illinois driver's license?
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Yes
No
How many driving accidents [whether at fault or not], violations, restrictions, or suspensions have you had within the last 3 years? Please explain:
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Education
High School
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Received Diploma or GED
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Yes
No
College/University
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Received degree
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Yes
No
Major:
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College/University
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Received degree
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Yes
No
Major:
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Other training/education?
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If you are attending or are planning to attend school/college, please explain details:
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Military service record
Have you ever served in the U.S. armed forces?
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Yes
No
If yes, what were your duties and did you receive any special training?
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employment history [List your last 3 employers starting with the most recent]
Employer 1
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Dates employed from:
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Street Address:
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City
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State
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Zip
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Phone Number
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Hours worked per week:
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Job Title:
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Immediate Supervisor/Title
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Nature of work performed:
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Reason for leaving:
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May we contact employer for reference?
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Yes
No
Comments:
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Employer 2
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Dates employed from:
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Street Address:
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City:
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State:
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Zip:
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Phone Number:
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Hours worked per week:
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Job Title:
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Immediate Supervisor/Title
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Nature of work performed:
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Reason for leaving:
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May we contact employed for reference?
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Yes
No
Comments:
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Employer 3
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Dates employed from:
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Street Address:
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City:
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State:
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Zip:
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Phone Number
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Hours worked per week:
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Job Title:
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Immediate Supervisor/Title:
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Nature of work performed:
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Reason for leaving:
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May we contact employer for reference?
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Yes
No
Comments
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In addition to your work history, what other experiences, skills, or qualifications would especially fit you for work with our Company?
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PLEASE READ CAREFULLY:
Applicant's Certification and Agreement:
I understand that under the Illinois Health Care Worker Background Check Act, the Company will request a criminal history record check on all direct care employees. An applicant will not be hired and an employee will be discharged if he/she has a record of conviction of any of the criminal offenses specified in the Act, unless the record is cleared or a waiver is received. I understand I have the right to obtain a copy of the criminal records report, challenge its accuracy/completeness, and request a waiver.
Signature of Applicant:
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Date:
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Please note that this application is considered current for ninety (90) days. If you want to be considered for employment after this time, you must complete another Application for Employment.
Submit
Home
About Us
History of OH
Board Members
Testimonials
Events
Pub Crawl
Volleyball Event
Band Together
Art Show & Open House
60th Gala
Work for OH
Services
24-hour Residential Care
In Home Support
>
Community Support
Home Based Support Services
Day Services
>
Community Day Services
Supported Employment
Recreational Programs
>
Recreational Activities
Special Olympics
Communications
FAQs
Newsletters
Annual Reports
Need a Presenter?
Contact
Donate
Donate Now
Annual Appeal
Wish Lists
Volunteer
Support Us
