Careers

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Name*

First Last

Date Of Birth*

Primary Telephone Number*

Email Address*

State*

Current Mailing Address (Street, City, State, Zip - No PO Boxes)*

Current Home Address (Street, City, State, Zip - No PO Boxes)*

Have you ever been convicted of a crime?*

Yes

Has adjudication ever been withheld for a crime?*

Yes

If you answered YES to either of the above, please give details referencing the type of crime, the date oF conviction and the penalty imposed. (Use separate paper if necessary) NOTE - A CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FROM CONSIDERATION.)

EMPLOYMENT OR AGENCY EXPERIENCE

PREVIOUS EMPLOYMENT AND AGENCY RELATIONSHIPS during the past ten (10) years from today's date (list most recent first)

Company*

Job Title*

Address (City, State, Zip)*

Dates Worked (Start Day, Last Day)*

Work Performed*

Reason for Leaving*

Company

Job Title

Address (City, State, Zip)

Dates Worked (Start Day, Last Day)

Work Performed

Reason for Leaving

Company

Job Title

Address (City, State, Zip)

Dates Worked (Start Day, Last Day)

Work Performed

Reason for Leaving

Have you ever been dismissed or forced to resign from any employment or agency relationship?*

Yes

If you answered YES, please explain:

CHARACTER REFERENCES

Do you have any friends or relatives who partner as a Licensee with OkemHomeBuyers.com?*

Yes

List one professional reference NOT RELATED TO YOU whom you have known for at least one year:

Name*

Occupation*

Email Address*

Phone Number*

Careers

EMPLOYMENT OR AGENCY EXPERIENCE

PREVIOUS EMPLOYMENT AND AGENCY RELATIONSHIPS during the past ten (10) years from today's date (list most recent first)

CHARACTER REFERENCES

List one professional reference NOT RELATED TO YOU whom you have known for at least one year:

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