Ojai Staff Application

Employment Application

Programs, services, and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview. Please note that employment is subject to a successful background check and fingerprinting.

Date of Interview

Please Select Department

Housekeeping
Maintenance
Kitchen
Dining Room

Application Data

How were you referred to us?

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Date Available to Start

Social Security Number

Salary Requirements

If you are under 18, can you provide a work permit?

Yes
No

If no, please explain:

Have you ever worked for this company?

Yes
No

If yes, when?

Are you legally allowed to work in the United States?

Yes
No

Type of employment desired:

Full-Time
Part-Time
Temporary
Seasonal

Have you ever pleaded guilty, no contest or been convicted of a crime?

No
Yes

Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

If yes, please give dates and details:

Education History

Name and Location of High School

Did you graduate?

Yes
No

Name and Location of College

Years attended:

Degrees completed:

Other subjects studied:

Trade, Business or Correspondence School:

Years attended:

Subjects studied:

Did you graduate?

Yes
No

Summarize Your Special Skills or Qualifications

Previous Employment (begin with most recent position)

Dates of Employment: From

To

Position(s) Held

Company Name

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reasons for Leaving

May we contact this emloyer for a reference?

Yes
No

Job #2

Dates of Employment: From

To

Position(s) Held

Company Name

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Reasons for Leaving

Ending Salary and Title

May we contact this emloyer for a reference?

Yes
No

Job #3

Dates of Employment: From

To

Position(s) Held:

Company Name

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reasons for Leaving

May we contact this emloyer for a reference?

Yes
No

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevent federal and state laws."

Signature of Applicant

Date