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2. We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis, including race, color, age, sex, religion, religion, disability, or national origin. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process.

4. Personal Information
6. Name
8. Physical Street Address
10. Physical City
11. Physical State
12. Physical Zip
14. Mailing Street Address
16. Mailing City
17. Mailing State
18. Mailing Zip
20. Telephone Number
21. Cell Phone Number
23. Are you 18 years of age or older?

    1. Yes

    1. No
24. Email Address
28. Employment Desired
30. Position
31. Date You Can Start
    Date You Can Start
32. Salary Desired
34. Are you employed now?

    1. Yes

    1. No
36. If employed now, may we inquire of your present employer?

    1. Yes

    1. No
38. Have you ever applied to the City of Skiatook before?

    1. Yes

    1. No
40. Where?
41. When?
45. Education
47. Name of Grammar School
49. Location of Grammar School
50. Years Completed
52. Did you graduate?

    1. Yes

    1. No
53. Subjects Studied and Degree Received
57. Name of High School
59. Location of High School
60. Years Completed
62. Did you graduate?

    1. Yes

    1. No
63. Subjects Studied and Degree Received
67. Name of College
69. Location of College
70. Years Completed
72. Did you graduate?

    1. Yes

    1. No
73. Subjects Studied and Degree Received
77. Name of Technical, Trade, or Business School
79. Location of Technical, Trade, or Business School
80. Years Completed
82. Did you graduate?

    1. Yes

    1. No
83. Subjects Studied and Degree Received
87. Subjects of Special Study or Research Work
89. Job Related Skills (typing, driver's license, etc.)
91. Have you ever pled "guilty" or "no contest" to, or been convicted of a crime (except minor traffic violations)?

    1. Yes

    1. No
93. If Yes, Please Give Details

    A "yes" answer does not automatically disqualify you from employment. Factors such as the date of the offense, the seriousness of the offense, rehabilitation, and position applied for will be taken into consideration.

97. Employment History

99. List your last four employers, starting with the most recent.

101. Start Date of Employment

     Month and Year

102. End Date of Employment

     Month and Year

104. Name of Employer
106. Address of Employer
108. City
109. State
110. Zip
112. Salary
113. Position
115. Reason for Leaving
119. Start Date of Employment

     Month and Year

120. End Date of Employment

     Month and Year

122. Name of Employer
124. Address of Employer
126. City
127. State
128. Zip
130. Salary
131. Position
133. Reason for Leaving
137. Start Date of Employment

     Month and Year

138. End Date of Employment

     Month and Year

140. Name of Employer
142. Address of Employer
144. City
145. State
146. Zip
148. Salary
149. Position
151. Reason for Leaving
155. Start Date of Employment

     Month and Year

156. End Date of Employment

     Month and Year

158. Name of Employer
160. Address of Employer
162. City
163. State
164. Zip
166. Salary
167. Position
169. Reason for Leaving
173. References

175. List three persons, not related to you, whom you have known for at least one year.

177. Name
179. Address
181. City
182. State
183. Zip
185. Telephone Number
186. Years Acquainted
190. Name
192. Address
194. City
195. State
196. Zip
198. Telephone Number
199. Years Acquainted
203. Name
205. Address
207. City
208. State
209. Zip
211. Telephone Number
212. Years Acquainted

214. If you are to be hired by the City, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

218. Authorization

220. I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the City.

     I understand that any employment is conditioned on a background check. I authorize the City to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the City, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigations or disclosure.

     I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at-will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the City. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the City unless made in writing.

     If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the City and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the City the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired, a condition of my employment will be that I abide by the City's Drug and Alcohol Policy.

     I understand that filling out this form does not indicate there is a position open and does not obligate the City to hire. If hired, I agree to abide by all City work rules, policies and procedures. The City retains the right to revise its policies or procedures, in whole or in part, at any time.

222. Date
     Date
223. Signature
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225. 1. Receive an email copy of this form.
226. Email address

     This field is not part of the form submission.

227. Submit Submit and Print

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