Employment Application

Employment Application

Equal Opportunity Employer
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.Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact

First NameLast Name
Emergency ContactPhone Number
Please enter a valid phone number.Format: (000) 000-0000.
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
Have you previously applied for employment with Kiamichi Tech?
Approximate date/s you applied:

MonthDayYear

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.Format: (000) 000-0000.
May we communicate with supervisor?
Title of position held:
Employee starting date:

MonthDayYear
Employee ending date:

MonthDayYear
Currently employed here:
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.Format: (000) 000-0000.
May we communicate with supervisor?
Title of position held:
Employee starting date:

MonthDayYear
Employee ending date:

MonthDayYear
Currently employed here:
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.Format: (000) 000-0000.
May we communicate with supervisor?
Title of position held:
Employee starting date:

MonthDayYear
Employee ending date:

MonthDayYear
Currently employed here:
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 of Discharge

MonthDayYear
Type of Discharge
Rank at Discharge

References
Reference #1 Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reference #2 Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reference #3 Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

Attachments
Cover Letter

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Resume

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Transcript 1

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Transcript 2

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Teaching Certificate

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Additional Documents

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Additional Documents

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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.
Contents © 2026 Kiamichi Technology Centers

Kiamichi Technology Center (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 the terms, conditions, privileges or responsibilities in admission to its programs and services, employment practices, treatment of individuals, or any aspect of its operations. The district also provides equal access to the Boy Scouts of America and other designated youth groups. This notice is provided in compliance with Title VI of the Civil Rights Act, Section 504/Title II of the Americans with Disabilities Act, Title IX, the Age Discrimination Act, and any other applicable federal or state anti-discrimination laws.

The following person has been designated to handle inquiries concerning application of KTC’s non-discrimination policies:

Kiamichi Tech Title IX/504 Coordinator,

Jay R. Warren

1004 Highway 2 North, Wilburton, OK. 74578

918-465-2323 jwarren@ktc.edu

Outside assistance may be obtained from:

U.S. Department of Education Office for Civil Rights

One Petticoat Lane 1010 Walnut Street, Suite 320, Kansas City, MO 64106

816-268-0550, 877-521-2172 (TTY)

OCR.KansasCity@ed.gov.
Full Name

First NameMiddle NameLast Name
Signature
Date

MonthDayYear
Should be Empty:

Employment Application

Employment History

Education and Military Experience

References

Attachments

Agreement (PLEASE READ CAREFULLY)