Fillable Printable Application for Employment Form - Oklahoma
Fillable Printable Application for Employment Form - Oklahoma
Application for Employment Form - Oklahoma
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State of Oklahoma
EMPLOYMENT APPLICATION
Office of Personnel Management
Jim Thorpe Memorial Office Building, Room B-22
2101 North Lincoln Boulevard • Oklahoma City, OK 73105 OPM website: www.opm.state.ok.us
(405) 521-2171 • (405) 521-6314 - TDD Number (You must have a TDD machine to use the TDD number.)
Please print clearly or type
Please read instructions on page 2 before completing the application
Social Security Number: ____________________________ Date of Application:____________________________
Name: __________________________________________________________________________________________
Last First Middle
Mailing Address: __________________________________________________________________________________
Street Address, Apt # City State Zip Code
County: _______
(Codes on page 2)
E-mail address ___________________________________________________
Evening Telephone:_____________________________ Day Telephone: _____________________________
(Include area code)
(Include area code)
JOB OR JOB FAMILY DESIRED:______________________________________________________
Indicate the conditions under which you will accept employment (Yes or No - If blank, YES is assumed)
Full-time: ___________ Part-time: ____________ Shift work: ____________
Travel: ____________ (Travel may include regular overnight or across town assignments)
Are you at least 21 years of age?_____ (Yes or No) (Will be used only where age is an approved, bonafide job requirement.)
List the county codes (listed on page 2) for which you wish to be considered for employment. If none are indicated it is assumed
you are willing to work anywhere in the state.
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____
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For Office Use Only
JFD Code A/R Code Score Initial/Date JFD Code A/R Code Score Initial/Date
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The Office of Personnel Management will remove this section
Voluntary Applicant Survey - The information requested will be used to assist state agencies in complying with state and federal record keeping and reporting
requirements. It may be made available to employing agencies when they exercise state laws authorizing affirmative action in hiring. Please provide accurate
information. Your cooperation is important and appreciated. For affirmative action purposes, state law requires any person who lists American Indian as
his/her race or ethnic group to verify tribal affiliation by providing a certificate of Degree of Indian Blood from the U.S. Department of Interior, Bureau of Indian
Affairs, or by providing the name and address of tribal officials who can verify tribal affiliation. Do NOT turn this verification in with this employment application.
It should be turned in to the hiring agency within thirty days of appointment.
Social Security Number:___________________ Sex:______ (M or F)
Race or Ethnic Group (Check only one)
1._____ Black (not of Hispanic origin)
2._____ Asian or Pacific Islander
3._____ American Indian or Alaskan Native
4. _____ Hispanic (Mexican, Puerto Rican, Cuban
Central or South American or other Spanish
culture or origin, regardless of race)
5. _____ White (not of Hispanic origin)
The State of Oklahoma is an Equal Opportunity Em ployer
OPM-4 (12/21/04) Page 1 of 4
Page 2 of 4
Employment Application Instructions
1. Answer all questions completely, as your score may be
based on a rating of this application. Be sure you have
all 4 pages for the application. Additional sheets may
be attached if necessary.
2. You may apply for one Job Family only per application.
Applications will only be processed for jobs and job
families currently announced for recruitment.
Applications for job families that are
not announced will
be returned to you. It is your responsibility to keep
current on positions announced for recruitment. This
information is on the OPM Recruitment Notice each
week, the OPM web site (address given on page 1 of
application), and at state agencies.
3. If you wish to claim veteran’s preference, complete form
OPM-75 and return it to the Office of Personnel
Management with the required proof.
4. The examinations are administered at the Office of
Personnel Management in Oklahoma City Monday –
Thursday from 9:00 a.m. to 4:45 p.m. or at the local
Career Technology Centers (listed below).
5. If you require special testing due to a disability, please
contact OPM to make arrangements. Persons with
disabilities may wish to request information on the
“Persons with Severe Disabilities” Employment
Program.
6. Applicant information will be entered into a computer
and all materials, including transcripts, will be available
to state agencies. If you get a state job, your file is
open to public inspection except for certain information
specifically required by law to be kept confidential. All
information provided during the application process is
subject to investigation and verification. Also, a
personal background investigation, including any
civilian or military court records, may be conducted.
7. With this application, a person agrees to the state’s
overtime pay policy, which allows giving compensatory
time instead of cash payments under certain conditions.
8. An original signature and date are required for each
application.
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County Number Codes
01 Adair
02 Alfalfa
03 Atoka
04 Beaver
05 Beckham
06 Blaine
07 Bryan
08 Caddo
09 Canadian
10 Carter
11 Cherokee
12 Choctaw
13 Cimarron
14 Cleveland
15 Coal
16 Comanche
17 Cotton
18 Craig
19 Creek
20 Custer
21 Delaware
22 Dewey
23 Ellis
24 Garfield
25 Garvin
26 Grady
27 Grant
28 Greer
29 Harmon
30 Harper
31 Haskell
32 Hughes
33 Jackson
34 Jefferson
35 Johnston
36 Kay
37 Kingfisher
38 Kiowa
39 Latimer
40 LeFlore
41 Lincoln
42 Logan
43 Love
44 McClain
45 McCurtain
46 McIntosh
47 Major
48 Marshall
49 Mayes
50 Murray
51 Muskogee
52 Noble
53 Nowata
54 Okfuskee
55 Oklahoma
56 Okmulgee
57 Osage
58 Ottawa
59 Pawnee
60 Payne
61 Pittsburg
62 Pontotoc
63 Pottawatomie
64 Pushmataha
65 Roger Mills
66 Rogers
67 Seminole
68 Sequoyah
69 Stephens
70 Texas
71 Tillman
72 Tulsa
73 Wagoner
74 Washington
75 Washita
76 Woods
77 Woodward
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Career Technology Centers
Contact the Career Technology Center nearest your home for information on test dates.
Ada Pontotoc Technology Center, 601 West 33rd Street 580-310-2271
Afton Northeast Technology Center, 19901 South Highway 69 918-257-8324
Alva Northwest Technology Center, 1801 South 11th 580-327-0344
Ardmore Southern Oklahoma Technology Center, 2610 Sam Noble Parkway 580-223-2070
Bartlesville Tri-County Technology Center, 6101 SE Nowata Road 918-331-3226
Burns Flat Western Technology Center, 621 Sooner Drive 580-562-3181
Durant Kiamichi Technology Center, 810 Waldron Road 580-924-7081
Enid Enid Community Learning Center, 2615 East Randolph 580-242-6600, ext. 123
Fort Cobb Caddo-Kiowa Technology Center, North Vo-Tech Rd. & 7th Street 405-643-5511
Guymon High Plains Technology Center, 712 Academy 580-338-0674
Idabel Kiamichi Technology Center, RR. 3, Box 177 Highway 70 580-286-7555
Lawton Great Plains Technology Center, 4500 West Lee Boulevard 580-351-6790
McAlester Kiamichi Technology Center, 301 Kiamichi Drive 918-426-0940
Okmulgee Green Country Technology Center, 1100 North Loop 56 918-756-1334
Poteau Kiamichi Technology Center, 1509 South McKenna 918-647-4525
Pryor Northeast Technology Center, 6 miles west on Highway 20 918-825-5555
Sapulpa
Tulsa
Central Tech, 1720 South Main
Downtown Tulsa Career Center, 2 North Elgin
918-224-9300
918-596-2147
Wayne Mid-America Technology Center, I-35 & Interchange 59 405-449-3391
Wetumka Wes Watkins Technology Center, 7892 Highway 9 405-452-5500
Woodward High Plains Tech, 3921 34th Street 580-571-6145
Page 3 of 4
Name:__________________________ Social Security Number:___________________________
EDUCATIONAL BACKGROUND
Are you a high school graduate or have you passed a general education development (GED) test? Yes_____ No_____
(Will only be used as required by statute, law or bonafide job requirement)
Are you fluent in any language other than English? List all
List colleges, universities or professional schools attended. If more space is needed, attach additional copies of this
page. (Transcripts may be required)
School Name
Location
From
Month/Year
To
Month/Year
Major/Minor or
Course of Study
Hours
Completed
Degree
Date
Completed
List any other job-related training or coursework: (vocational, trade, governmental, business, Armed Forces, etc.)
School Name
Location
From
Month/Year
To
Month/Year
Course of Study
Hours
Completed
Date
Completed
List job-related licensure, registration or certification (teacher certification, nursing licensure, trade licensure, etc.)
License, Registration
or Certification
Number
Date Received
Expiration Date
Licensing Agency
or Board
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Title 21 O.S. Section 358: “It shall be unlawful for any person applying for employment with the St ate of Oklahoma to make a materially
false, fictitious or fraudulent statement or representation on an employment application, knowing such statement or representation to be
materially false, fictitious or fraudulent. A violation of this subsection shall be punished as provided in subsection B of the Section 359
of this title.”
STATEMENT OF CERTIFICATION By signing this application I certify that the facts contained in this application packet are true and
complete to the best of my knowledge. I understand that if I become employed, falsified statements on this application may be grounds
for dismissal and/or removal from consideration for eligibility for other state employment or employment examinations. I authorize
investigation of all statements and information contained herein. Specifically, I authorize the State of Oklahoma to make all necessary
and appropriate investigations allowable by law to verify the information provided. I understand that if I am hired I will be required to
produce proof that I have a legal right to work in the U.S.A. in accordance with the Immigration Reform and Control Act of 1986.
________________________________________________________________________________________________
Sign Your Name Here Date
Page 4 of 4
Name:__________________________ Social Security Number:___________________________
EMPLOYMENT HISTORY
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate
rank) and volunteer work. List each promotion or transfer as a separate job, even if they were with the same employer. If
needed, attach additional copies of this page. All information in this section must be completed. Resumes cannot be
used as a substitute for the completed application. Employers and supervisors may be contacted regarding your
work experience.
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Employer’s Name and Address _______________________________________________________________________
Exact Title of Your Position___________________________________________________________________________
From (Month/Year) _______________ To (Month/Year) _____________ Average Hours Per Week ____________
Duties (Be specific - attach extra signed and dated sheets, if necessary): ______________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Approximate Ending Salary ___________ Supervisor’s Name and Title____________________________________
Number and Occupation of Employees you Supervised ____________________________________________________
Reason for Leaving ________________________________________________________________________________
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Employer’s Name and Address _______________________________________________________________________
Exact Title of Your Position___________________________________________________________________________
From (Month/Year) _______________ To (Month/Year) _____________ Average Hours Per Week ____________
Duties (Be specific - attach extra signed and dated sheets, if necessary): ______________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Approximate Ending Salary ___________ Supervisor’s Name and Title____________________________________
Number and Occupation of Employees you Supervised ____________________________________________________
Reason for Leaving ________________________________________________________________________________
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________________________________________________________________________________________________
Sign Your Name Here Date