An Equal Opportunity Employer

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EMPLOYMENT APPLICATION

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age,
sexual orientation, marital or veteran status, the presence of a non-job-related medical condition or
handicap, or any other legally protected classification. Those applicants requiring reasonable
accommodation to the application and/or interview process should notify a representative of the Human
Resources Department. Drug screening may be a requirement for employment; if you do not feel you
could pass a pre-employment drug test, do not fill out this application. Note: All applicants will be
required to furnish proof of identity and legal work authorization to be considered for employment.

General Information (Please Print) Date of Application: ____________________

Position Applied for:


Name:
Last First MI

Current Address:
Street Date at this Location


City State Zip

E-Mail Address: Home Phone: ( )

Cell: ( ) Preferred Contact Method

Previous Address:
(If at current address less than 4 years) Street Length of time at this address



City State Zip


How were you referred to OPKO?

Have you ever been employed by OPKO or an affiliate company? No Yes if yes, please give specifics:

Are you eligible to work in the US without sponsorship? No Yes If no, list the type of sponsorship needed.






(MA Residents, please skip this section until you have been selected for employment.)
Have you ever been convicted of any crime other than a minor traffic violation? No Yes

If yes, Please explain (include dates, offenses, location):
(Conviction will not necessarily be a bar to employment each instance and explanation will be considered in relation to the position for which you are applying.)







Military Service
Have you ever served in the Military: No Yes Branch of Service:

Date of Service From: To: Rank at Discharge/Separation:

Job Specialty or Classification:
An Equal Opportunity Employer
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Employment History Starting with your most recent employer, provide the following information:

Employer: From: To:
Position Held: Complete Address: Telephone: (Include Area Code)
Immediate Supervisor and Phone Number: Reason for Leaving:
Summary of Job Responsibilities:
May we contact? Yes No Later
Starting Salary: Ending Salary:

Employer: From: To:
Position Held: Complete Address: Telephone: (Include Area Code)
Immediate Supervisor and Phone Number: Reason for Leaving:
Summary of Job Responsibilities:
May we contact? Yes No Later
Starting Salary: Ending Salary:

Employer: From: To:
Position Held: Complete Address: Telephone: (Include Area Code)
Immediate Supervisor and Phone Number: Reason for Leaving:
Summary of Job Responsibilities:
May we contact? Yes No Later
Starting Salary: Ending Salary:

Employer: From: To:
Position Held: Complete Address: Telephone: (Include Area Code)
Immediate Supervisor and Phone Number: Reason for Leaving:
Summary of Job Responsibilities:
May we contact? Yes No Later
Starting Salary: Ending Salary:

An Equal Opportunity Employer
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Educational Information

Name and Location
(City, State)
Attendance
Dates
Did You
Graduate?
Degree
Received
Course of Study
High School Not Applicable
Yes No
Not Applicable
College

Yes No

College

Yes No

Other Training

Scholarships, Honors, Assistantships, etc.

Professional Association / Memberships / Licenses
Identify memberships and offices held in any professional, trade, business or work-related organizations, as well as
any work-related licenses,certifications or professional designations.





Computer Skills
Identify computer software programs that you are familiar with:





Professional References Identify at least three people who are business references or previous
employers.
Name Relationship/Company Name
Daytime
Telephone Number
Years
Known













An Equal Opportunity Employer
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Applicant Acknowledgement and Consent for Release of Information

I certify that the answers given on this application or accompanying resume are true and complete to the best of my
knowledge. I understand that if employed, any misrepresentation or material omission made by me on this
application or resume will be sufficient cause for immediate discharge.

It is understood that employment at OPKO Health, Inc. or any of its subsidiaries is upon my completing a pre-
employment drug test.

I understand that this application is not, and is not intended to be, a contract of employment . I fully understand that
all employees of OPKO Health, Inc. are employed at the will of the Company and is not for an indefinite period. I
understand that employees may resign from the Company at any time, for any reason or no reason, with or without
cause, or with or without notice. I understand that no manager or representative of the Company, other than the
CEO, has any authority to enter into any agreement for employment for specific period of time or to make any
agreement contrary to this statement.

I understand that company handbooks, policy statements, and practices are not express or implied contracts or
promises which are binding on the Company. I further understand that I am expected to follow all policies and
company rules. I also acknowledge that policies and benefits contained in these handbooks, policy statements or
practices may be changed or discontinued at any time, at the Companys discretion.

As a condition of employment, I authorize the preparation of a background investigative report. For this purpose, I
authorize all persons, schools, companies, corporations, credit bureaus, former employers and municipal, county,
state, and federal agencies to provide all information that is requested concerning my background to the Company or
its agency. I further release all of the above including the Company and its agent to the full extent permitted by
law from any claims, damages, losses, liabilities, and expenses arising from the retrieving and reporting of
information. I am also hereby notified that I may be contacted to obtain additional information related to the
preparation of a background report. Results will be used to determine employment eligibility by authorized
representatives of the Company. All reports willl be CONFIDENTIAL.


_________________________________________________________ ______________________________
Signature Date



An Equal Opportunity Employer
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