Onyx - Employment Application

Personal details

Last Name*

First Name*

Middle Name

Date*

Email*

Social Security Number*

Telephone *

Present Address

Street*

City*

State*

Zip*

Are you at least twenty one (21) years of age? Yes No
please indicate DOB*

I have lived at the above address since (month\year) *

All OSL, LLC. employees may be required to drive company vehicles. Because of this, the following information is needed.

Do you have a valid New Mexico Driver License:* Yes No

If yes, complete below

License # *

License Class *

Are you an insured New Mexico motorist:* Yes No

Have you been convicted of a DWI within the past five (5) years:* Yes No

Do you have any moving traffic violations within the past three (3) years:* Yes No

If yes, list offenses and dates:*

PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS COMPLETELY

1. Position you are applying for*

2. Desired salary*

3. When can you begin work? *

Full Time or Part Time? *

4.Have you applied previously for employment at OSL LLC? * Yes No

5. How were you referred to Onyx Supportive Living, LLC? *

6. Are you available to work:*

Weekends? *

Yes No

Nights? *

Yes No

Holidays? *

Yes No

Shifts may vary given the need of the program

7. A dependable vehicle is required and must be available to you while on the job. Do you have your own vehicle for reliable transportation, which can be used for conducting agency business when necessary? *

Yes No

8. Have you ever possessed or used illegal drugs? *

Yes No

If yes, please explain

9. Have you ever been arrested for, charged with or convicted of any violation of any Federal, State, County or Municipal law, regulation or ordinance? All charges must be included even if they were dismissed. An affirmative answer will not necessarily disqualify you from being considered for employment. (Include traffic violations) *

Yes No

If yes, please explain

10. Have you ever been arrested or convicted of offenses dealing with the mistreatment or abuse of children or others? *

Yes No

If yes, please explain

11. Are you now or have you ever been on parole or probation? *

Yes No

If yes, please explain

12. Have you ever been discharged from any employment? *

Yes No

If yes, please explain

13. Have you ever had a job which required a Criminal Records Check by the state of New Mexico? *

Yes No

If yes, please give employer name and dates of employment

EDUCATION

Do you have a High School Diploma, GED equivalent or higher form of education? *

Yes No

WORK EXPERIENCE

ACCOUNT FOR ALL EMPLOYMENT, SELF EMPLOYMENT, UNEMPLOYMENT FOR THE PREVIOUS FIVE (5) YEARS OR BACK TO YOUR EIGHTEENTH (18TH) BIRTHDAY (if you are less than twenty-four (24) years of age)

Name of Present or Previous Employer *

Job Title *

Ending Pay *

Address*

City*

State*

Telephone *

Dates of Employment From *

To *

Reason for Leaving *

Name of Supervisor *

Duties and Responsibilities *

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ONYX SUPPORTIVE LIVING LLC

EMPLOYMENT APPLICATION