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Personal Information

Position(s) Desired:*
Date of Application*
Date of Application
Referred By (If no referral, enter "Self-Referred"): *
Date Available for Work: *
Are you available for work:*
1. full time
2. part time
3. shifts
4. weekends
5. nights
If part time, explain hours and days that you are available:
Last Name:*
First Name:*
Middle Initial:
Street Address:*
City:*
State: *
Zip:*
Home Phone:*
Business Phone:
Email address:*
If you are under 18 years of age, can you provide proof of your eligibility to work?:
1. Yes
2. No
3. Not Applicable
Have you ever worked for this City?*
1. Yes
2. No
If yes, give prior name (if applicable), dates, and reason for leaving:
Some positions require the successful candidate to have a valid driver's license. The successful candidate would have to provide proof that s/he has a valid driver's license when offered employment. Do you hold a current Driver's License?*
1. Yes
2. No
If yes, list endorsements such as Oklahoma Operator, Commercial, or Chauffeur's, etc. If no license, enter "NA":*
Has your license been revoked or suspended in the last 5 years? A non-acceptable driving record may include more than 2 moving violations within the past 3 years; more than one at-fault accident in the past 3 years; or any DWI or DUI or reckless driving (alcohol or drug related) within the last 5 years:*
1. Yes
2. No
If yes, list year and reason of revocation/suspension:
Are you related to any City employee or any member of the City Council?*
1. Yes
2. No
If yes, give name, department, and relationship:
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Employment Experience

List Most Recent First
1. Employer Name & Address:*
Employment Dates:*
Employment Dates: Start Date
—
Employment Dates: End Date
Currently Employed Here:*
1. Yes
2. No
Job Title:*
Work Performed:*
Starting Salary/Rate:*
Final Salary/Rate:*
Reason for Leaving:
2. Employer Name & Address:
Employment Dates:
Employment Dates: Start Date
—
Employment Dates: End Date
Currently Employed Here:
1. Yes
2. No
Job Title:
Work Performed:
Starting Salary/Rate:
Final Salary/Rate:
Reason for Leaving:
3. Employer Name & Address:
Employment Dates:
Employment Dates: Start Date
—
Employment Dates: End Date
Currently Employed Here:
1. Yes
2. No
Date Started:
Date Ended:
Job Title:
Work Performed:
Starting Salary/Rate:
Final Salary/Rate:
Reason for leaving:
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Background Information

Have you been convicted of a felony in the last 7 years or are you currently charged with the commission of a felony?*
1. Yes
2. No
If yes, state what, when, and how (Note: This information does not in itself disqualify you for employment):
Military Service - Branch:
Date entered
Date entered
Date and Type of Discharge:
Indicate specific military experience or training that is job related:
If you have any additional information or comments concerning any voluntary experience, licenses, or training which would help us determine your suitability for this position, please describe:
Are you legally eligible to be employed in the United States? (Proof of Identity and eligibility will be required upon employment):*
1. Yes
2. No
Can you preform the essential job functions of the position for which you are applying?*
1. Yes
2. No
3. I have not reviewed the Essential Functions
If no, please explain
The City is concerned with your ability to perform the job and will not at this time consider your need for reasonable accommodation. If after reviewing your application form, verifying your responses, and conducting necessary interviews or tests, you are considered for the job and would need reasonable accommodation to perform the essential job functions the parties will explore these alternatives.
REMEMBER: The City may conduct a pre-employment exam, which will determine whether you can do the essential functions of the job without substantial risk to yourself and the public.
In addition, review the attached minimum qualifications and provide us with prior education, work experience, and any relevant training or certificates and licenses that would indicate your knowledge, skills, and abilities to perform the job. Be as specific as possible since you will be considered on what you include regardless of what you might otherwise be able to perform.
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Education

References

Provide three (3) professional references who are not related to you.
Reference 1
Name:*
Phone (include area code):*
Email Address:*
Describe your professional relationship:*
Reference 2
Name:*
Phone Number (include area code):*
Email Address:*
Describe your professional relationship:*
Reference 3
Name:*
Phone Number (include area code):*
Email Address:*
Describe your professional relationship:*
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Disclaimers and Signatures

APPLICANT'S STATEMENT
Certain jobs are classified as “safety sensitive” as defined by the United States Department of Transportation drug, alcohol testing regulations, The Oklahoma Standards for Workplace Drug and Alcohol Testing Act and/or Oklahoma Medical Marijuana laws. As a “safety sensitive” classification, you will be subject to drug and alcohol testing, including random testing. Marijuana is one of the substances included in the drug panel screening. Possession of a medical marijuana license will not excuse you from the testing process, or the consequences of testing positive for marijuana. If you have questions about whether the position you are applying for is classified as “safety sensitive” please consult with the HR Department.
By entry of my name in this blank, I certify that I understand and agree to all of the preceding, and that this entry of my name represents my signature:*
Date:*
Date:
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I agree to submit to a pre-employment medical examination, which will include a drug and alcohol screen. I hereby release the City and its agenda from all liability in making any investigation and inquiry relative to information contained in this application. I understand that this application is not a contract for employment.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby acknowledge that any employment relationship with the City as of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the City.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
By entry of my name in this blank, I certify that I understand and agree to all of the preceding, and that this entry of my name represents my signature:
*
Date:*
Date:
Supplemental Documentation: You may choose to upload a resume, cover letter, copies of certificates or other documentation that may be relevant to the job for which you are applying.

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