Employment Application

Complete The Online Application

If you are interested in submitting an application to Independent Opportunities, you may complete and submit the online application form at the bottom of this page.

You may also download and print a PDF version of our application if you prefer to email it to us or deliver it in person.

Apply Online Now

Download a PDF Application

You may download and print the Employment Application in PDF format by clicking the button below. You may email your completed application to bheath@indopp.com or deliver it to one of our office locations.

Download A PDF Application

Apply Online Now

Independent Opportunities is an equal opportunity employer.

All statements made by applicants for employment on this application form will be checked for accuracy. We offer equal employment opportunities to all persons without discrimination on the basis of race, color, religion, age, sex, national origin, citizenship status, physical or mental disability, or past, present, or future service in the Uniformed Services of the U.S. or any other legally protected status. The use of this form does not mean there are positions open and does not obligate us in any way.

Application Date *

Position You Are Applying For *

Type of Work Desired: *

Full-time
Part-time

Your Details

Name *

First

Last

Email *

Phone *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you at least 18 years of age? *

Employment is subject to verification of minimum legal age.

For purpose of compliance with the immigration reform and control act, are you legally eligible for employment in the United States? *

You must be able to provide proof, such as a driver’s license, Social Security card, birth certificate, and/or Immigration and Naturalization Service Documents.

Immigration reform and control act of 1986, you will be required to complete certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect, should you be employed.

Will You Accept Appointments Only In Certain Locations?

If Yes, What Locations? *

Have you ever been convicted of law violation(s), including moving traffic violations, but excluding offenses before your eighteenth birthday which were adjudicated in a juvenile court or under a youth offender law? (copy) *

If Yes, Please Explain:

Do You Consent To A Background Check? *

This agency will require all employees have a criminal records check to be completed by the Kentucky State Police at the point of employment.

Would You Provide Your Own Transportation If Necessary For Your Employment? *

What Date Are You Available To Begin Working? *

Education Details

Give complete information for all your education and training. If you have completed college work, you may be requested to furnish an official transcript of all completed work.

Enter the highest grade you have completed: *

Did you complete high school? *

If you did not complete high school, do you have a high school equivalency diploma or GED? *

Enter the Number of Years of Post High School Education

Please list the colleges, universities or institutions you have attended. Please include their location, how many hours you attended, your major/minor, and any degrees you have received: *

Employment History

Begin with present or last job and describe accurately the duties of each position.

Company / Business Name of most recent employer:

Name of Supervisor at most recent employer: *

First

Last

Address of most recent employer: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number for most recent employer: *

Date Hired: *

If not sure of exact date, please make your best estimate.

Are you still employed with this company? *

Date Left: *

If not sure of exact date, please make your best estimate.

Starting pay rate:

Current / Final pay rate:

Please provide your job title, along with a description of your duties & responsibilities: *

Please provide your reason for leaving: *

May we contact this employer? *

Company / Business Name of 2nd most recent employer:

Name of Supervisor at 2nd most recent employer:

First

Last

Address of 2nd most recent employer:

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number for 2nd most recent employer:

Date Hired:

Date

Time

If not sure of exact date, please make your best estimate.

Are you still employed with this company?

Date Left:

If not sure of exact date, please make your best estimate.

Starting pay rate:

Current / Final pay rate:

Please provide your job title, along with a description of your duties & responsibilities:

Please provide your reason for leaving:

May we contact this employer?

If you have a resume, you may upload it here in PDF format (optional):

Click or drag files to this area to upload. You can upload up to 3 files.

You may upload your resume in PDF format.

Job Applicant’s Agreement and Certification

Applicant understands that Independent Opportunities is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type, with the application being fully completed for it to be considered. Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that all entries on this application and all attachments are true and complete. I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture, on my part, of any employment with Independent Opportunities. I understand that all information on this application is subject to verification and I consent to references, former employers, and educational institutions listed being contacted regarding information disclosed. The Human Resources Director and/or Executive Director may disseminate information contained on this application to other agencies, non-governmental organizations, or systems on a need-to-know basis, for good cause.

Applicant Signature *

Applicant's Full Name *

Date *

Date

Time