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On-line Employment Application

*First Name:
*Last Name:
*Phone:
*Email Address:
Position Applied for:
Starting Salary Desired:
Permanent Address:
City:
State:
Zip:
Temporary Address:
City:
State:
Zip:
Are you authorized to work in the United States?  Yes No
Have you ever been employed by Orange County National?  Yes No
If yes, provide dates:
Do you have any relatives or acquaintances employed by Orange County National?  Yes No
If yes, provide names:
Are you applying for:  Full Time Part Time Temp / Seasonal
Have you ever pleaded no contest to or been convicted of a misdemeanor or any felony in the past 7 years?  Yes No
If yes, explain fully?

A conviction will not necessarily bar you from employment, but will be weighed on its own merit with respect to time, circumstances, seriousness, and the position for witch you have applied.

Educational History

Highest Grade Completed: College: Graduate School:

High School
School Name:
Location:
Major:
Year Completed:
Did you Graduate?
Degree or Certificate:
Date of Leaving:
Trade
School Name:
Location:
Major:
Year Completed:
Did you Graduate?
Degree or Certificate:
Date of Leaving:
College
School Name:
Location:
Major:
Year Completed:
Did you Graduate?
Degree or Certificate:
Date of Leaving:
Other Give Type
School Name:
Location:
Major:
Year Completed:
Did you Graduate?
Degree or Certificate:
Date of Leaving:
US Military Service Branch: Duties:
From (MM/YY):
To (MM/YY):
Discharge Type:
Rank at Discharge
US Military Reserve Status:
Do you possess a Valid Driver's License: Type:  Operator Commercial
State:
Class:
Endorsements:
How were you referred to Orange County National?
When are you available to begin work?
Can you work: (check all that apply)
 Weekends Days Evenings Night Hours Holidays Over Time Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Please list any other skills, specialized training or additional information that are relevant to your ability to perform the position for which you are applying:
   

Employment History
Employment Experience - Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude voluntary work that indicates race, color religion, gender nation origin, handicap or other protected status. Please account for all time for at least the past five year.

Employer:
Address:
Phone:
Job Title:
Supervisor:
Reason for leaving:
Dates Employed:
Hourly Rate/Salary:
Work Performed:
May we contact this employer?  Yes No
Employer:
Address:
Phone:
Job Title:
Supervisor:
Reason for leaving:
Dates Employed:
Hourly Rate/Salary:
Work Performed:
May we contact this employer?  Yes No
Employer:
Address:
Phone:
Job Title:
Supervisor:
Reason for leaving:
Dates Employed:
Hourly Rate/Salary:
Work Performed:
May we contact this employer?  Yes No
   

If hired and requested by the Company, I agree to submit to a physical examination before being finally accepted for employement and I also agree that, in the event the Company shall employ me, I will submit to further physical examinations when requested by the Company. I hereby authorize any physical, surgeon, practitioner or other person (and any hospital, including veterans administration or governmental hospital, or any medical service organization), any insurance company or other institution or organization to release to the Company and to each other any medical or other information acquired, including benefits paid or payable concerning the undersigned. All Medical examinations will be job related and consistent with business necessity. I further agree to forfeit my statutory rights to ownership of any lost or abandoned personal property found by me on the Company's property.

I authorize my former employers and other individuals to give information concerning me whether or not it is on their records, and I release them and their companies from any liability whatsoever. I certify that all statement given on this application are correct, and realize that falsifications, omissions, and or misrepresentations on this or any other personnel record may result in my discharge. In the event of employment, I agree to abide by all present and subsequently issued rules of the Company. Also in the event of employment and in Consideration thereof, the Company, and any person or concern it may authorize, shall be entitled, without further consent to copyright, sell or use in any manner, any picture or photogragh of me, or recording of my voice.

FLORIDA'S WORKER'S COMPENSATION DRUG FREE WORKPLACE CONSENT AGREEMENT

I UNDERSTAND THAT IT IS THE POLICY OF THIS COMPANY THAT IT IS A CONDITION OF EMPLOYMENT FOR AN EMPLOYEE TO REFRAIN FROM REPORTING TO WORK OF WORKING WITH THE PRESENCE OF DRUGS OR ALCOHOL IN HIS OR HER BODY.

IN COMPLIANCE WITH THE REQUIRMENTS OF THE FLORIDA DRUG FREE WORKPLACE RULES ESTABLISHED BY THE DIVISION OR WORKER'S COMPENSATION, I HAVE RECEIVED A COPY OF THE COMPANY'S DRUG FREE WORKPLACE POLICY AND CONSENT TO ITS TERMS. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE THAT I UNDERSTAND MY RIGHTS, DUTIES, AND OBLIGATIONS UNDER THIS DRUG FREE WORKPLACE PROGRAM.

I UNDESTAND ALL APPLICANTS ARE REQUIRED TO SUBMIT TO A URINE DRUG TEST AND MUST AGREE TO SUBMIT TO THE URINE SAMPLE COLLECTION AND DRUG TESTING AS PART OF THE APPLICATION FOR EMPLOYMENT.

I UNDERSTAND THAT IF AN APPLICANT REFUSES TO SUBMIT TO THE DRUG TEST OR FAILS TO QUALIFY ACCORDING TO THE MINIMUM STANDARDS ESTABLISHED BY THE COMPANY WILL DISQUALIFY THE APPLICANT FROM FURTHER CONSIDERATION FOR EMPLOYMENT.

I UNDERSTAND IF THERE IS A BASIS FOR REASONABLE SUSPICION TESTING, I MAY BE REQUIRED TO SUBMIT TO A URINE DRUG TEST AND/OR A BLOOD ALCOHOL TEST. I ALSO UNDERSTAND THAT FAILURE TO COMPLY WITH A DRUG TESTING REQUEST OR A POSITIVE RESULT MAY LEAD TO TERMINATION OF MY EMPLOYMENT.

I UNDERSTAND THAT THE MEDICAL REVIEW OFFICER (MRO) APPOINTED BY THIS COMPANY WILL MAINTAIN THE RESULTS OF THE DRUG TEST. THE MEDICAL REVIEW OFFICER WILL REPORT ALL RESULTS, NEGATIVE AND POSITIVE, TO THE COMPANY.

IF MY POSITION WITH THE COMPANY IS SUBJECT TO DOT REGULATIONS, I UNDERSTAND THAT TESTING WILL BE CONDUCTED FOLLOWING THE RULE OD 49 PART 40.

I AGREE TO THE TERMS AND REGULATIONS LISTED ABOVE ON THIS ONLINE APPLICATION

I AGREE TO THE TERMS AND REGULATIONS LISTED ABOVE ON THIS ONLINE APPLICATION

  I AGREE DATE:
Please attach your cover letter and resume (PDF or MS Word document are preferred)