Employment Application Which location are you applying for?* Kalamazoo Grand Rapids Ann Arbor Name* First Last Email* Drivers License # Are you 18 or older?* Yes No Permanent Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Other PhoneAvailabilityApplying for position When can you start?* MM slash DD slash YYYY Can you work weekends/holidays?* Yes No Do you have transportation to work?* Yes No Hours Available to Work*1-56-1010-2020-4040+Sunday Availability: Leave blank or write N/A if unavailableMonday Availability: Leave blank or write N/A if unavailableTuesday Availability: Leave blank or write N/A if unavailableWednesday Availability: Leave blank or write N/A if unavailableThursday Availability: Leave blank or write N/A if unavailableFriday Availability: Leave blank or write N/A if unavailableSaturday Availability: Leave blank or write N/A if unavailableWork Experiencelist present or most recent firstCompany Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Supervisor Phone Date Started MM slash DD slash YYYY Date Left MM slash DD slash YYYY Wage Reason for leaving? Company Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Supervisor Phone Date Started MM slash DD slash YYYY Date Left MM slash DD slash YYYY Wage Reason for leaving? Company Name Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position Supervisor Phone Date Started MM slash DD slash YYYY Date Left MM slash DD slash YYYY Wage Reason for leaving? ReferencesPlease do not list relatives or former employersReference #1 Name Occupation PhoneReference #2 Name Occupation PhoneReference #3 Name Occupation PhoneDuring the last 7 years, have you ever been convicted of a crime, excluding misdemeanors and traffic violations?*The existence of a criminal record does not constitute an automatic bar to employment. Yes No If Yes, please describe in detail:Please introduce yourself and tell us why you would be a good candidate for employment with The Oasis.*Emergency InformationEmergency Contact Name* In case of emergency, please contact ... Relationship* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Signature I certify that the infomation contained in this application is correct to the best of my knowledge and understand that any omission or erroneous information is grounds for dismissal. I authorize the references listed above to give you any information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parites from all liability that may result from furnishing this information. I acknowledge that The Oasis has the right to amend or modify the policies in its handbook or other Oasis policies at any time, without prior notice. These policies do not create any promises or contractual obligations between The Oasis and its employees. At The Oasis, my employment is at will. This means I am free to terminate my employment at any time, for any reason, with or without cause, and The Oasis retains the same rights. Only The Oasis Board of Directors may make an exception to this, and it must be done in writing. The Oasis is an Equal Opportunity Employer. I consent to The Oasis obtaining any job-related information in connection with this application for employment. 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