INLAND EMPIRE & DESERT COMMUNITIES

APPLICATION INFO:

Position Applying For:
Expected Pay Rate: Date Available to start work:
Full or Part time? If PT, what hours?
How did you hear of Olive Crest? (please be specific):

PERSONAL INFORMATION:

NAME     First: Middle: Last:
Street:
City: Date of last TB Test:
State: Zip: Date of last Physical:
Home Phone: Driver's License Number:
Cell Phone: Driver's License State:
Email:
Are you 18 years of age or older?     If NO, state your age:

ADDITIONAL INFORMATION:

  * A-G are required fields

A. After employment, can you submit verification of your legal right to work in the Unites States?   *
B. Were you previously employed by us? If Yes, when? Please state name if different:   *
C. Can you work overtime?   *
D. Did you serve in the military?   *
E. With or without accommodation, can you perform the duties of this job?
(please answer this question after reviewing the job description for which you are applying) 		  *
F. Have you ever been convicted of a crime?
(Employment is contingent upon clearance of your criminal record) 		  *
G. Has your driver's license ever been suspended or revoked?   *

If your answer to F or G above is YES, please provide the following information:

DATE LOCATION NATURE DISPOSITION

NOTE: This application contains information for LIC 501 (12/90)

EDUCATION:

Select highest year completed:
Did you receive a diploma?
CURRENTLY ENROLLED IN HIGH SCHOOL COMPLETION COURSE?
If YES, please give an estimated completion date:
UNDERGRADUATE AND GRADUATE LEVEL EDUCATION:
Name of University,
College, or Business School		 Major / Subject Years
Completed		 Units
Completed		 Degree / Certificate Date
Completed
EMPLOYMENT-RELATED EDUCATION COURSES COMPLETED:
Name of University,
College, or Business School		 Title of Course Units
Completed		 Date
Completed
EMPLOYMENT-RELATED EDUCATION COURSES CURRENTLY ENROLLED:
Name of University,
College, or Business School		 Title of Course Projected
Units		 Expected
Completion
Describe any specialized training, apprenticeships, skills, and extra-curricular activities:
List licenses or certificates of competence held:
Honors received:
List professional, trade, business, or civic associations of which you are a member (you may exclude groups which indicate race, color, religion, sex, age, or other protected status):
What languages do you speak, read, or write fluently?
State any additional information you feel may be helpful to us in considering your application:

EMPLOYMENT HISTORY:

Please fill out all employment information as completely as possible, starting with your present or most recent employment.
You may also include any applicable volunteer experience or military service assignments.

Employment is contingent on the accuracy and completion of current and previous employment

*Olive Crest does not solicit any contact information, including e-mail, as it is solely used to complete reference checks in a timely manner.
WE RESERVE THE RIGHT TO CONTACT ALL CURRENT AND FORMER EMPLOYERS
Company Name
Telephone
Fax
Job Title
HRS per week
 Dates of Employment (State month and year)
   From:      To:
Address (Street, City, State, Zip)
Name of Supervisor
 *Supervisor E-mail
Describe Your Work
 Reason For Leaving
Company Name
Telephone
Fax
Job Title
HRS per week
 Dates of Employment (State month and year)
   From:      To:
Address (Street, City, State, Zip)
Name of Supervisor
 *Supervisor E-mail
Describe Your Work
 Reason For Leaving
Company Name
Telephone
Fax
Job Title
HRS per week
 Dates of Employment (State month and year)
   From:      To:
Address (Street, City, State, Zip)
Name of Supervisor
 *Supervisor E-mail
Describe Your Work
 Reason For Leaving

PROFESSIONAL REFERENCES:

List three people who are not related to you, who are not previous supervisors, and who can give information about your background,
character, abilities, etc., from a professional perspective.

Examples may include (but not limited to): current/previous professors, academic advisors, co-workers, members
from group/volunteer organizations. Please provide complete, accurate, up to date information, as employment is contingent
upon satisfactory completion of reference checks.

*Olive Crest does not solicit any contact information, including e-mail, as it is solely used to complete reference checks in a timely manner.
Name
Relationship
 Address
*E-mail Home # Cell #
Name
Relationship
 Address
*E-mail Home # Cell #
Name
Relationship
 Address
*E-mail Home # Cell #

APPLICANT'S STATEMENT

By clicking submit I certify that the answers given herein are true and complete to the best of my knowledge. If I am employed, I understand that false or misleading information given on this application or during interview(s) may result in discharge at any time.

By clicking submit I authorize investigation of all statements contained in this application. I authorize Olive Crest to contact any of my references, employers and/or schools, except as otherwise indicated, and authorize my references, employers and/or schools to furnish any information concerning my employment, education and/or background, character, abilities, etc. I release Olive Crest and all persons and organizations from all claims and liabilities of any nature arising from such inquiries and investigations.

By clicking submit I understand that employment at Olive Crest is “at will”. If I am employed, I, at my own discretion, or Olive Crest, at its own discretion, may terminate my employment at any time with or without cause and with or without notice.