Employment Application

OMNI Orthopaedics

4760 Belpar St. NW Canton Ohio 44718
Ph. (330) 492-9200 Fax. (330) 492-5454

OMNI Orthopaedics is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Personal Information:
Last*
M.
First*
Email*
Street Address*
City*
State*
Zip Code*
Home Phone:*
Cell Phone:*

Employment:
Postion applying for:*
Select Availability:*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Hours available to work:*
Salary Desired:*
Are you available to work overtime?*
How did you hear about this position?*
Do you have transportation to and from work?*
Date available to start employment:*
MM slash DD slash YYYY

Job Skills/Qualifications:
Please list the skills and qualifications you possess for the position for which you are applying:*
(Note: OMNI Orthopaedics complies with the ADA and considers reasonable accomodation measures that may be necessary for eligible applicants/employees to perform essential job functions.)

High School*

Name	Location	Year Graduated	Degree

College/University

Name	Location	Year Graduated	Degree

Vocational School/Specialized Training

Name	Location	Year Graduated	Degree

Military:
Are you a member of the Armed Services?*
- Yes
- No
If yes, which branch:
How many years did you serve in the military?
What military skills do you possess that would be an asset for this position?

Previous Employment:

1 of 3
Employer Name:*
Job Title:*
Supervisor Name:*
Employer Address:*
Phone:*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Reason for leaving:*
Starting position pay rate:*
Final position pay rate:*

Previous Employment:

2 of 3
Employer Name:
Job Title:
Supervisor Name:
Employer Address:
Phone:
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for leaving:
Starting position pay rate:
Final position pay rate:

Previous Employment:

3 of 3
Employer Name:
Job Title:
Supervisor Name:
Employer Address:
Phone:
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for leaving:
Starting position pay rate:
Final position pay rate:

References:

Please provide three (3) personal references below:

List references*

Name	Phone Number	Email

At-Will-Employment:

The relationship between you and OMNI Orthopaedics is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or OMNI Orthopaedics. No representative of OMNI Orthopaedics has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will" and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and Operations Officer or the Company's CEO.
Consent*
I agree to the privacy policy.
WEBSITE PRIVACY POLICY
OMNI Orthopaedics, Inc. is committed to protecting online user privacy. This privacy policy (“Policy”) describes our practices regarding information that we may collect when you visit our website, www.omniorthopaedics.com (“Site”). This Policy does not apply to information collected by any other websites.

We encourage you to read this Policy before using our Site. By using this Site, you agree to the terms and conditions of this Policy as well as to the Site’s Terms of Use.

Information We May Collect Through the Site
When you visit the Site, OMNI Orthopaedics, Inc and third parties with whom we have contracted to provide certain website services collect generic information regarding your visit available from your internet browser (“Session Data”). Session Data includes the type of browser you use (for example, Internet Explorer), how you got to the Site (for example, from a search engine or a link), the IP address from which you visit the Site, the pages visited on the Site and the amount of time spent on the Site. We do not link Session Data with personally identifiable information.

We do not collect personal information about you unless you voluntarily provide it, such as by signing up to receive email alerts or submitting an information request. Personal information that you might provide to us when using such a function of the site includes your email address, name, telephone number, and mailing address.

How We Use Information We Collect
We, and third party service providers we may use to assist us with Site design and maintenance, analyze Session Data only in the aggregate to understand Site traffic and usage, maintain the Site, improve Site content and make the Site more useful to visitors.

We use personal information you provide through the Site solely for the purpose of providing the information and services you request. For example, we may use your personal information to fulfill your requests for information and communicate with you about those requests or provide email updates to which you subscribe.

With Whom Information May Be Shared
We do not sell, lease or license your personal information to any party for any purpose, nor do we share it with third parties for marketing purposes. We may share your personal information with third party service providers with whom we contract for the purpose of processing your information requests and payments. These companies are authorized to use your personal information only as necessary to provide these services and are required to maintain the confidentiality of such information.

We may also disclose your personal information if we believe we are required to do so by law, regulation, or legal processes, such as a search warrant, subpoena or court order. We may need to disclose personal information in exceptional circumstances, such as to protect against malicious and/or unauthorized access, to protect legal rights or to address actual or threatened illegal or harmful conduct.

Cookies
To collect the Session Data described above, this Site uses “session cookies.” A session cookie is a small amount of data sent from a website to your internet browser, temporarily placed on the hard drive of your computer and deleted from your hard drive once you close your browser. These “session cookies” do not collect, store or transmit personal information. Some websites (but not this Site) use cookies that remain on your hard drive so the website will recognize you as a return visitor.

Links to Third Party Sites
This Site may contain links to third party websites. Such websites are not under OMNI Orthopaedics, Inc. control and we are not responsible for the privacy practices of such websites. We encourage you to read the privacy policies of each website that collects information from you.

Children’s Information
We do not intend to collect any personal information from children through this Site. Please do not allow children under the age of 13 to provide any personal information in connection with this Site. If we determine that a child under 13 has provided personal information through this Site, we will delete that information as soon as practicable. If you become aware that personal information has been provided by a child under 13, please contact us at the address below so we can delete such information.

Changes to This Policy
OMNI Orthopaedics, Inc. reserves the right to modify this Policy at any time without prior notice. If we revise this Policy, we will post the revised version on this page with an updated effective date. Use of the Site following such changes constitutes your acceptance of the terms of the Policy then in effect. We encourage you to periodically visit this page to ensure familiarity with the most current version of our Policy.

Privacy Policy Questions
Should you have questions or comments regarding this Policy, please write to us at:
OMNI Orthopaedics, Inc.
4760 Belpar Street NW,
Canton, OH 44718
Phone: 330-492-9200
customerservice@omniorthopaedics.com
Signature*
Print Name:*
Date*
MM slash DD slash YYYY
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Step 1 of 11

OMNI Orthopaedics

Personal Information:

Employment:

Job Skills/Qualifications:

Military:

Previous Employment:

Previous Employment:

Previous Employment:

References:

Please provide three (3) personal references below:

At-Will-Employment:

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