Omni Components promotes a drug-free workplace.
Pre-employment drug screening is performed on all prospective employees.
Omni Components is an equal opportunity employer.

* Required

Personal Information

First Name: *

Middle Initial:

Last Name: *

Address:

City:

State:

Zip:

Home Telephone: *

Business Telephone:

Email Address: *

Have you ever applied for employment with us?

Yes: No:

If yes: Month: January February March April May June July August September October November December Year: 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990

Location:

Position desired:

Date available to start:

Month: January February March April May June July August September October November December Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Salary desired:

Did you serve in the U.S. armed forces?

Yes: No:

If yes: what branch? Army Navy Air Force Marine Corp Coast Guard National Guard Other

Describe any training received
relevant to the position for which
you are applying.

Other special training or skills:
(languages, machine operations, etc.)

Education

High School:

Did you graduate? Yes No

Diploma or Degree:

Trade or Business:

Did you graduate? Yes No

Diploma or Degree:

College:

Did you graduate? Yes No

Diploma or Degree:

Previous Employment

Company Name: *

Address:

City, State, Zip:

Telephone: *

Job title/Description of work:

Supervisor:

Dates of employment:

Weekly pay:

Reason for leaving:

Comments:

Company Name:

Address:

City, State, Zip:

Telephone:

Job title/Description of work:

Supervisor:

Dates of employment:

Weekly pay:

Reason for leaving:

Comments:

Company Name:

Address:

City, State, Zip:

Telephone:

Job title/Description of work:

Supervisor:

Dates of employment:

Weekly pay:

Reason for leaving:

Comments:

References

Name:

Business:

Telephone:

Years known:

Name:

Business:

Telephone:

Years known:

Name:

Business:

Telephone:

Years known:

Drug Screen

* "I understand that I am subject to drug testing if Omni offers me a position. I further understand that a negative drug test result is a condition of employment. If I am employed by Omni, and I am involved in a workplace
accident or if the company reasonably suspects that I am under the influence of an illegal drug, I will be subject to drug testing."

Agree: Do not agree:

Authorization

"I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above."

Attach Resume (if available):