Employment Application

Phone

This field is for validation purposes and should be left unchanged.

APPLICANT INFORMATION

Name*

First Name Middle Last Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Alternate Phone

Best Contact Time

:

Position/s Applying For

When are you available to Begin Work?*

Type of Work Desired*

Full-Time
Part-Time
Temporary/Contract

Will You Work Overtime?*

Yes
No

If hired, can you provide evidence that you are authorized to work in the United States and 18 years old or older?*

Yes
No

Emergency Contact Name

Emergency Contact Telephone

Name of Nearest Relative

Nearest Relative Telephone

How did you hear about us?

EDUCATION

Education Type*

High School
Business / Technical
College
Graduate
Other

School - Course of Study - Years Attended - Degree/Diploma

PROFESSIONAL ORGANIZATIONS & TRAINING

First-Aid Training?*

Yes
No

CPR Training?*

Yes
No

First-Aid Training Date Completed

CPR Training Date Completed

PREVIOUS EMPLOYMENT

Current Employer

Currently not Employed

I am Currently Not Employed

Company Name

Company Telephone

Company Address

Street Address City State / Province / Region ZIP / Postal Code

Position Held

From Date

To Date

Starting / Ending Salary

Supervisor

Reason For Leaving

Previous Employer #1

Company Name

Company Telephone

Company Address

Street Address City State / Province / Region ZIP / Postal Code

Position Held

From Date

To Date

Starting / Ending Salary

Supervisor

Reason For Leaving

Previous Employer #2

Company Name

Company Telephone

Company Address

Street Address City State / Province / Region ZIP / Postal Code

Position Held

From Date

To Date

Starting / Ending Salary

Supervisor

Reason For Leaving

Military Status

Have You Served in the U.S. Armed Services?

Yes
No

Branch

Start Date

End Date

Rank/Rate at Discharge

Type of Service

Type of Discharge

Special Training/Experience Received in the U.S. Armed Services

Draft Status

Reserve Status

CRIMINAL HISTORY

Have you ever been convicted of a criminal offense?*

Yes
No

Are you currently on probation or parole?*

Yes
No

Do you currently have any criminal actions pending in which you are the Defendant?*

Yes
No

If you answered "Yes" to any of the above questions, please explain the nature of the offense and provide the date of the offense and the county and state in which it occurred.

Have you ever pleaded guilty, been convicted, received court-ordered community service, deferred adjudication, probation or pre-trial diversion, misdemeanor or felony? (Excluding minor traffic offenses and/or plea of guilt or conviction that has been sealed pursuant to Okla. Stat. title 22 § 19 or any other state regulation). Note: Conviction will not necessarily disqualify you from the position for which you are applying.

Check One*

Yes
No

If yes, please list and explain.

PERSONAL REFERENCES

Reference #1 (Name / Address / Phone / Occupation / Relationship)

Reference #2 (Name / Address / Phone / Occupation / Relationship)

Reference #3 (Name / Address / Phone / Occupation / Relationship)

Additional Information

Include any other information that may be helpful i.e. certifications, licenses, skills etc.

Consent*

I agree

I certify that my answers are true and complete to the best of my knowledge. I understand and agree that any material misrepresentation
or deliberate omission of a fact in my application may result in refusal of, or if employed, immediate termination from employment.
Although management makes every effort to accommodate individual preference, business needs may at times make the following
conditions mandatory: overtime, shift work, rotating work schedule, or a work schedule other than Monday through Friday. I understand
and accept these as conditions of my continuing employment. It is my understanding that a thorough investigation may be made
into my entire work history and all data given in my application for employment, related papers, or oral interviews. I authorize such
investiagtions and the giving and receiving of any information requested and I release from liability any person giving or receiving
such information. I acknowledge that any oral representation or written statements, which may have been made to me, to the contrary
of this paragraph, are expressly disavowed and may not be relied upon.

I also understand that a test for illegal controlled substances will be conducted at the expense of the Company as part of the Company’s
selection and hiring process. Any offer made to an applicant is conditional upon successful completion of the drug screen.

Date*

CAPTCHA

We look forward to hearing from you.

APPLICANT INFORMATION

EDUCATION

PROFESSIONAL ORGANIZATIONS & TRAINING

PREVIOUS EMPLOYMENT

Current Employer

Previous Employer #1

Previous Employer #2

Military Status

CRIMINAL HISTORY

PERSONAL REFERENCES

Additional Information