Employment Application

Employment Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency ContactPhone Number*
Please enter a valid phone number.
Are you 18 years of age or older? *
Are you legally eligible for employment in the United States? *
Have you been convicted of a felony? *
If yes, explain:
Do you have any relatives that work at Kiamichi Tech? *
If yes, list their names:
Which position are you interested in? *
Campus:*
Briefly state reason for interest in employment with Kiamichi Tech:*
How were you referred to Kiamichi Tech?*
Salary Requirements: *
Date available to work: *

MonthDayYear
Date
Have you previously applied for employment with Kiamichi Tech? *
Approximate date/s you applied:

MonthDayYear
Date

Employment History
Name of last employer:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Title of Supervisor
Phone Number of Supervisor
Please enter a valid phone number.
May we communicate with supervisor?
Title of position held:
Employee starting date:

MonthDayYear
Date
Employee ending date:

MonthDayYear
Date
Currently employed here:

Yes
Reason for leaving:
Describe the position responsibilities:
Name of last employer:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Title of Supervisor
Phone Number of Supervisor
Please enter a valid phone number.
May we communicate with supervisor?
Title of position held:
Employee starting date:

MonthDayYear
Date
Employee ending date:

MonthDayYear
Date
Currently employed here:

Yes
Reason for leaving:
Describe the position responsibilities:
Name of last employer:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Supervisor

First NameLast Name
Title of Supervisor
Phone Number of Supervisor
Please enter a valid phone number.
May we communicate with supervisor?
Title of position held:
Employee starting date:

MonthDayYear
Date
Employee ending date:

MonthDayYear
Date
Currently employed here:

Yes
Reason for leaving:
Describe the position responsibilities:

Education and Military Experience
High School
Years Completed
Degree Awarded
Major
Minor
Business or Technical School
Years Completed
Degree Awarded
Major
Minor
College or University
Years Completed
Degree Awarded
Major
Minor
Graduate School
Years Completed
Degree Awarded
Major
Minor
Branch of Service:
Date Entered

MonthDayYear
Date
Date of Discharge

MonthDayYear
Date
Type of Discharge
Rank at Discharge

References
Reference #1 Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Reference #2 Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Reference #3 Name*

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Attachments
Cover Letter

Upload PDF or Word Documents Only
Cancelof
Resume

Upload PDF or Word Documents Only
Cancelof
Transcript 1

Upload PDF or Word Documents Only
Cancelof
Transcript 2

Upload PDF or Word Documents Only
Cancelof
Teaching Certificate

Upload PDF or Word Documents Only
Cancelof
Additional Documents

Upload PDF or Word Documents Only
Cancelof
Additional Documents

Upload PDF or Word Documents Only
Cancelof

Agreement (PLEASE READ CAREFULLY)
I hereby affirm that all statements made herein are true and correct. I authorize Kiamichi Technology Centers (herein called Kiamichi Tech), to conduct whatever investigation it deems necessary to confirm the information given on this application and in an interview. I understand and agree that any false or misleading information given or omission of fact shall be sufficient grounds for dismissal.

I authorize any agent, firm, former employer, person, school, or organization given as a reference to answer any and all questions that may be asked, to give any information that may be requested in connection with this application. I also certify the agent, firm, former employer, person, school, or organization who may furnish such information concerning me shall not be held accountable for giving this information. I hereby release the said agent, firm, former employer, person, school, or organization from any and all liability as a result of furnishing such information.

I understand that Kiamichi Tech has a responsibility to employ only those persons who are qualified in every respect.

I understand that it is the policy of Kiamichi Tech to conduct a national criminal history records check on every prospective employee of Kiamichi Tech pursuant to 70 O.S. section 5-142 as amended.

I understand I may be employed on a temporary basis for up to sixty (60) days pending the receipt of the national criminal history records check search results.
Full Name

First NameMiddle NameLast Name
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Kiamichi Tech does not discriminate on the basis of race, color, sex, pregnancy, gender, gender expression or identity, national origin, religion, disability, veteran status, sexual orientation, age, or genetic information with respect to its programs or any aspect of its operations. The following person has been designated to handle inquiries concerning the application of Kiamichi Tech non-discrimination policies:

Jay R. Warren, Title IX Coordinator,

1004 Highway 2 N

Wilburton, OK 74578

(918) 465-2323.
Should be Empty:

Employment Application

Employment History

Education and Military Experience

References

Attachments

Agreement (PLEASE READ CAREFULLY)