OMARK Consultants, INC. is always looking for leak survey consultants.

OMARK Consultants, INC. Employment Application
We Are An Equal Opportunity Employer

Name & Address First Name: *  MI: Last Name: * Street: * City: * State: * Zip: * Are you over 18? * Yes No Home Phone: * Work Phone: E-mail: * Other names, assumed names or nicknames to help us check your records:

Past Employment Information We must have accurate and complete information on previous job tasks and levels of responsibility, as your work experience is an important factor in evaluating your qualifications. List names of employers in consecutive order with present or most recent employer listed FIRST. Account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and business references.   Current or Most Recent Employer Employer: Title: Type of Business: Street: Phone: City: State: Country: Starting Pay Rate: Ending Pay Rate: Duties: Start Date: End Date:    Reason for leaving:    Last Supervisor's Name & Title:    May we contact current employer: Yes    No   Previous Employer 1 Employer: Title: Type of Business: Street: Phone: City: State: Country: Starting Pay Rate: Ending Pay Rate: Duties: Start Date: End Date:    Reason for leaving:    Last Supervisor's Name & Title:   Previous Employer 2 Employer: Title: Type of Business: Street: Phone: City: State: Country: Starting Pay Rate: Ending Pay Rate: Duties: Start Date: End Date:    Reason for leaving:    Last Supervisor's Name & Title:   Previous Employer 3 Employer: Title: Type of Business: Street: Phone: City: State: Country: Starting Pay Rate: Ending Pay Rate: Duties: Start Date: End Date:    Reason for leaving:    Last Supervisor's Name & Title:   Additional Previous Employers - use the Other Information field below and use same format as above.

Education - High School or GED Name: Last Year Completed: 9 10 11 12 GED Address:   Education - College or University   (most recent first) School: Degree Received: Course of Study: No. Years Completed: Address: Country: School: Degree Received: Course of Study: No. Years Completed: Address: Country: School: Degree Received: Course of Study: No. Years Completed: Address: Country:

Other Information, Education, Training or Relevant Experience List any other education, training, volunteer work, or relevant experience that would be of further assistance in evaluating your qualifications. Include dates, names of schools, length or experience, etc.

Special Skills What skills do you have that are related to the job(s) you are applying for? What machines or equipment can you operate that are related to the job(s) you are applying for? Do you type? Yes No     Typing speed: WPM

Driver's License For jobs requiring a valid driver's license or Commercial Driver's License (CDL). Commercial Driver's License(CDL) positions require a "Driver's Supplemental Application" which can be obtained from the HR Department. State: Class: Number: Expiration Date:

General Have you previously been employed by Omark? Yes No    Date: If veterans points are applicable, are you claiming Veteran's Preference status? Yes No

Convictions Have you ever been convicted of any law violation (include whether you are currently subject to a deferred sentence) except minor traffic violations? Yes No If yes, give details: (A conviction does not automatically disqualify you from employment, since the nature and date of the offense, the job(s) for which you are applying, and other factors will be considered.)

References List three persons who are not related to you and who have definite knowledge of your business or professional qualifications for the position for which you are applying. Do not repeat names of supervisors listed under work history. First Name: Last Name: Occupation: Street: City: State: Zip: Country: Phone: E-mail: First Name: Last Name: Occupation: Street: City: State: Zip: Country: Phone: E-mail: First Name: Last Name: Occupation: Street: City: State: Zip: Country: Phone: E-mail:

Resume If you wish, you may attach your resume to this application. Enter the file name or browse to select the file. (Microsoft Word or ASCII text preferred)