Fillable State Of Oklahoma Employment Application printable pdf download

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:

(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: _______

E-mail address ___________________________________________________

(Codes on page 2)

Evening Telephone:_____________________________

Day Telephone: _____________________________

(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

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)

4. _____ Hispanic (Mexican, Puerto Rican, Cuban

2._____ Asian or Pacific Islander

Central or South American or other Spanish

3._____ American Indian or Alaskan Native

culture or origin, regardless of race)

5. _____ White (not of Hispanic origin)

The State of Oklahoma is an Equal Opportunity Employer