Employment Application We look forward to hearing from you. APPLICANT INFORMATIONName* First Name Middle Last Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Alternate PhoneBest Contact Time : Hours Minutes AM PM AM/PM 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 TelephoneName of Nearest Relative Nearest Relative TelephoneHow did you hear about us?EDUCATIONEducation Type* High School Business / Technical College Graduate Other School - Course of Study - Years Attended - Degree/DiplomaPROFESSIONAL ORGANIZATIONS & TRAININGFirst-Aid Training?* Yes No CPR Training?* Yes No First-Aid Training Date Completed MM slash DD slash YYYY CPR Training Date Completed MM slash DD slash YYYY PREVIOUS EMPLOYMENTCurrent EmployerCurrently not Employed I am Currently Not Employed Company Name Company TelephoneCompany Address Street Address City State / Province / Region ZIP / Postal Code Position Held From Date MM slash DD slash YYYY To Date MM slash DD slash YYYY Starting / Ending Salary Supervisor Reason For LeavingPrevious Employer #1Company Name Company TelephoneCompany Address Street Address City State / Province / Region ZIP / Postal Code Position Held From Date MM slash DD slash YYYY To Date MM slash DD slash YYYY Starting / Ending Salary Supervisor Reason For LeavingPrevious Employer #2Company Name Company TelephoneCompany Address Street Address City State / Province / Region ZIP / Postal Code Position Held From Date MM slash DD slash YYYY To Date MM slash DD slash YYYY Starting / Ending Salary Supervisor Reason For LeavingMilitary StatusHave You Served in the U.S. Armed Services? Yes No Branch Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY 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 HISTORYHave 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 REFERENCESReference #1 (Name / Address / Phone / Occupation / Relationship)Reference #2 (Name / Address / Phone / Occupation / Relationship)Reference #3 (Name / Address / Phone / Occupation / Relationship)Additional InformationInclude any other information that may be helpful i.e. certifications, licenses, skills etc.Consent* I agreeI 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* MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
