Employee Application Form

Please fill out the following form to the best of your ability and submit the form for consideration. Omega will endeavor to contact you within five business days after submission to confirm to you that we have received your application form and to discuss the role and prospects for employment with Omega. Please fill out all relevant data fields to expedite consideration. All fields with a red asterisk are required fields and must be filled out before the application can be submitted.

Note: if you have an electronic resume you can probably copy resume text into many of the application fields to facilitate completing the application form.
Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mobile Phone Mobile Phone * - ### - ### ####
Other Phone Other Phone - ### - ### ####
Email *
Date Available to Start Work Date Available to Start Work * / MM / DD YYYY
Job or Role Applying For: *
Are you applying for Full Time or Part Time employment? *

Are you applying for Full Time or Part Time employment? Full Time Part Time
Do You have a current, valid Driver’s License? *

Do You have a current, valid Driver’s License? Yes No
Is your license a CDL (Class A Commercial Driver’s License) or does it have a CDL endorsement?

Is your license a CDL (Class A Commercial Driver’s License) or does it have a CDL endorsement? Yes No
Do you have reliable transportation for commuting to/from Omega office in Aberdeen? *

Do you have reliable transportation for commuting to/from Omega office in Aberdeen? Yes No
Do you have a clean driving record for the last five years (no DWI/DUI, no arrests, no accidents, no reckless driving convictions)? *

Do you have a clean driving record for the last five years (no DWI/DUI, no arrests, no accidents, no reckless driving convictions)? Yes No
Are you a citizen of the US? *

Are you a citizen of the US? Yes No
If you are not a Citizen of the US please indicate if you are legally allowed to work in the US.

If you are not a Citizen of the US please indicate if you are legally allowed to work in the US. Yes No
Have you ever been convicted of a Felony? *

Have you ever been convicted of a Felony? Yes No
If yes what was the charge?
If yes provide dates and details
Are you currently in the US Military or did you previously serve in the US Military *

Are you currently in the US Military or did you previously serve in the US Military Yes No
If you have served in the Military, please provide dates of service start and end, highest rank, and brief description of your responsibilities within the Military
Please be advised that as a condition of employment:
- Omega will order a pre-employment background investigation to include a credit check
- Omega will order a pre-employment drug screen, and may order periodic drug screens during employment
- If the role involves driving Omega vehicles, Omega will order a pre-employment copy of the applicant’s driving record.
- If the role involves driving Omega vehicles, Omega will require that Omega’s insurance company agree to insure the employee as a commercial driver for Omega’s vehicles
- If an employee takes drugs or consumes alcohol or other substance where the employee is or may be impaired during work hours, that employee may be subject to immediate termination of employment
Do you understand and accept that each of these four conditions will be requirements of employment with Omega? *
Please be advised that as a condition of employment:
- Omega will order a pre-employment background investigation to include a credit check
- Omega will order a pre-employment drug screen, and may order periodic drug screens during employment
- If the role involves driving Omega vehicles, Omega will order a pre-employment copy of the applicant’s driving record.
- If the role involves driving Omega vehicles, Omega will require that Omega’s insurance company agree to insure the employee as a commercial driver for Omega’s vehicles
- If an employee takes drugs or consumes alcohol or other substance where the employee is or may be impaired during work hours, that employee may be subject to immediate termination of employment
Do you understand and accept that each of these four conditions will be requirements of employment with Omega?
Yes No
Many Omega positions, including crew and climber positions, require having very good health and the ability to work outdoors in all 12 months of the year, from 9-10 hours per day, 5-7 days per week, in all weather conditions and requires safe construction practices. Additionally climbers and crew members must have use of all limbs (legs, arms, hands, etc.) and the ability to carry or lift a minimum of 50 pounds. Crews will also travel in Omega vehicles to work on jobs across the Carolinas and the mid-Atlantic States.

Do you confirm that you have the required physical condition to perform the role for which you have applied? Y/N *

Many Omega positions, including crew and climber positions, require having very good health and the ability to work outdoors in all 12 months of the year, from 9-10 hours per day, 5-7 days per week, in all weather conditions and requires safe construction practices. Additionally climbers and crew members must have use of all limbs (legs, arms, hands, etc.) and the ability to carry or lift a minimum of 50 pounds. Crews will also travel in Omega vehicles to work on jobs across the Carolinas and the mid-Atlantic States.

Do you confirm that you have the required physical condition to perform the role for which you have applied? Y/N Yes No
Are you able to travel when and as required to complete work in Omega’s service area? Please clarify any travel or work restrictions (such as certain days of the week that you cannot work).
Employment History

Please identify your last (4) Employers including all requested information. Start with your most recent (or current) employer and list employers from most recent to least recent:
Company 1 / Current or Most Recent
Company Name *
City *
State *
Start Date Start Date * / MM / DD YYYY
Finish Date: Finish Date: * / MM / DD YYYY
Job Title *
Roles and Responsibilities *
Reason for Leaving *
Starting Salary or Pay Rate *
Ending Salary or Pay Rate *
Company 2 /Employer Before Company 1
Company Name
City
State
Start Date Start Date / MM / DD YYYY
Finish Date: Finish Date: / MM / DD YYYY
Job Title
Roles and Responsibilities
Reason for Leaving
Starting Salary or Pay Rate
Ending Salary or Pay Rate
Company 3/Employer Before Company 2
Company Name
City
State
Start Date Start Date / MM / DD YYYY
Finish Date: Finish Date: / MM / DD YYYY
Job Title
Roles and Responsibilities
Reason for Leaving
Starting Salary or Pay Rate
Ending Salary or Pay Rate
Company 4/Employer Before Company 3
Company Name
City
State
Start Date Start Date / MM / DD YYYY
Finish Date: Finish Date: / MM / DD YYYY
Job Title
Roles and Responsibilities
Reason for Leaving
Starting Salary or Pay Rate
Ending Salary or Pay Rate
Education
Do you have a High School Diploma or GED? *

Do you have a High School Diploma or GED? Yes No
Provide details regarding your High School education including School Name, City and State of School, Date of Graduation or Completion
Do you have a College degree? *

Do you have a College degree? Yes No
Provide details regarding your College education including School Name, City and State of School, Type of Degree (AA, AS, BA, BS, etc.) Issued, Degree Program Completed or Program in which you were enrolled), Date(s) of attendance start/finish
Have you completed any specialized training programs? *

Have you completed any specialized training programs? Yes No
Provide details regarding your training including School or Training Company Name, City and State of Training, Type of Training received, Date(s) of attendance start/finish
Certifications
Do you hold any certifications? This may include military training certifications, or climbing certifications, safety, first aid, driver, project management, or other certifications or credentials. *

Do you hold any certifications? This may include military training certifications, or climbing certifications, safety, first aid, driver, project management, or other certifications or credentials. Yes No
Provide details regarding your Certifications including Certification Type or Name, Company or Service that issued the Certification, ID #, Date of Certificate award and expiration
Computer Skills/ Equipment
Can you use a personal computer or tablet PC to include email, internet browsing, Excel, Word, PowerPoint, Adobe, and other software? Please identify the software programs which you are able to use: *
Do you have a smart phone, laptop or tablet PC which you can use every day to clock in and clock out for your work hours? *

Do you have a smart phone, laptop or tablet PC which you can use every day to clock in and clock out for your work hours? Yes No
Knowledge, Skills and Abilities (KSA's)
What special knowledge, skills and abilities do you have that Omega should know about?
Signature

Please enter your complete name below as you sign your name. This confirms that all information in this application is accurate to the best of your ability to provide it.
Full Name *
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Employee Application Form

Employment History

Company 1 / Current or Most Recent

Company 2 /Employer Before Company 1

Company 3/Employer Before Company 2

Company 4/Employer Before Company 3

Education

Certifications

Computer Skills/ Equipment

Knowledge, Skills and Abilities (KSA's)

Signature