Personal/Background Information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Your Email Address *

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Cell Phone Number *

Preferred Position *

Date Available to Start *

Home Phone Number

Preferred Salary

How Were You Referred to Our Company

OBT BLUEFIELD works a rotating shift schedule. You may be required to work days, evenings or overnight shifts on a rotation. You may also occasionally be required to work holidays and weekends. Please check the box that applies to your availability:

Shift Availability *

Yes, I can work any and all shifts.
No, I have limited availability and can discuss in an interview.

Are You Able to Get to and from Work in Accordance with the Company Attendance Policy? *

Yes
No

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Are You Legally Entitled to Work in the United States? *

Yes
No

Proof of eligibility required upon employment.

Do You Have Any Relatives or Friends Currently Employed by OBT Bluefield?

Yes
No

Are You at Least 18 Years of Age? *

Yes
No

All applicants, once selected for employment, will complete a background check authorization and pre-employment drug test. All offers of employment are made contingent upon completion and successfully passing the background check and drug test screening criteria. Conviction of a felony or misdemeanor will not automatically disqualify an applicant for employment. All felony criminal convictions will be evaluated on a case by case basis to determine severity, relevancy, and recency in relation to the available position.

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Have You Ever Been Convicted of a Felony? *

Yes
No

Your Qualifications *

Please state your unique qualifications for the position, including special skills, etc.

Past Experience *

Describe your prior work experience and attendance.

Education

High School

9
10
11
12

Select highest level of education completed in years.

College

Select highest level of education completed in years.

Vocational or Other

1
2
3
4

Select highest level of education completed in years.

High School

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College

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Vocational/Other

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Work History/Employment Background/Military Service

List all previous employers. Do not skip any job. Begin with your present employer. Include military service, if desired.

May We Contact Your Current Employer?

Yes
No

Have You Ever Served in the US Military?

Yes
No

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Work History 1

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Begin Date

Company Name

Supervisor Name, Title, & Phone Number

Describe Responsibilities

Reason for Leaving

End Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Work History 2

Layout

Begin Date

Company Name

Supervisor Name, Title, & Phone Number

Describe Responsibilities

Reason for Leaving

End Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Work History 3

Layout

Begin Date

Company Name

Supervisor Name, Title, & Phone Number

Describe Responsibilities

Reason for Leaving

End Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

References

Do Not Use Relatives

Reference 1

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Reference Name *

Company Name

Phone *

Years Known *

Relationship *

Occupation *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference 2

Layout

Reference Name *

Company Name

Phone *

Years Known *

Relationship *

Occupation *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference 3

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Reference Name *

Company Name

Phone *

Years Known *

Relationship *

Occupation *

Address

Address Line 1

Address Line 2

City

State

Zip Code

AFFADAVIT: READ CAREFULLY BEFORE SIGNING

I understand that OBT BLUEFIELD, LLC, (“the Company”), insists that all of its employees are able to perform the essential functions of their employment as well as possess the character, integrity, and general reputation for honesty that the Company would itself represent in its dealings with customers, suppliers, and associates, among others. Accordingly, the Company insists on complete honesty.

I therefore, authorize the Company to make whatever inquiries it deems appropriate to verify any information given in my application and/or determine my qualifications and ability to perform the job to which I am applying. I understand that my consideration for employment is contingent upon the results of background, credit and reference checks, including verification of inquiries into my character, work performance, general reputation, and personal characteristics, where permitted by state/federal law. I expressly hereby give my consent for all contacted persons to provide information concerning this application and I release each such person from liability for providing information to the Company.

I hereby certify that the information contained in this application is correct to the best of my knowledge and I understand that falsification of this application in any detail, including misrepresentation or omission of facts, is grounds for disqualification from further consideration for employment, or for dismissal from employment at a later date. Furthermore, I agree to conform to the rules and regulations of the Company. I additionally understand that my employment is at will for no definite period of time, that I am free to leave employment at any time and for any reason, and that the Company may terminate my employment at any time, with or without cause, and/or notice. I further understand that none of the Company's written policies, manuals, handbooks, or other documents should be construed as creating any contractual obligations on the part of the Company. I acknowledge and understand that no one at the Company is authorized to make a contract of employment with me unless the document is in writing and signed by the President or Owner of the Company.

Signature of Applicant *

Date

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Please upload a resumé, certifications, and any other supporting documents.

Careers

OBT Bluefield Job Application

Personal/Background Information

Education

High School

College

Vocational/Other

Work History/Employment Background/Military Service

Work History 1

Work History 2

Work History 3

References

Reference 1

Reference 2

Reference 3

AFFADAVIT: READ CAREFULLY BEFORE SIGNING