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JOB APPLICATION
Hot Coffey
2024-11-27T13:14:39-06:00
Job Application
Fill out the online application below or
click here to download the PDF application
1
Personal Information
2
Special Questions
3
Employment Desired
4
Educational Background
5
Personal References & Emergency Contact
Hidden
Source
Personal Information
Before completing your employment application, we want you to know some very important information. Central State adheres to a set of values that places emphasis on ongoing development of the
character
of the citizens we serve and the employees who serve them as each continues to evolve as a contributing member of the community. Central State is committed to providing a
drug and alcohol free workplace
in order to insure quality services to the citizens we support. As an ongoing condition of employment, you may be selected to participate in random and for cause
alcohol and drug testing
SUBSTANCES COVERED BY THE TESTING ARE:
ALL
DRUGS & ALCOHOL. Before an interview, you will be expected to provide a complete employment history.
Applicants should be aware that hiring decisions are based on a competitive interview that focuses on learning about an applicant’s character development, previous work experience and skill level.
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Suffix
Date
*
Month
Day
Year
Present Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Secondary Phone
Other Phone
Message Phone
Special Questions
How did you hear about CSCSO?
*
Do you have a current, valid and unrestricted driver's license?
*
Yes
No
Do you have other commitments and responsibilities that could prevent your regular attendance at work?
*
Yes
No
If yes, please explain.
This position might require overtime and/or excessive hours. Would you be able to meet this requirement?
*
Yes
No
Have you ever pled guilty or no contendre to, been convicted of, received a deferred/suspended sentence, or been placed on probation for a criminal offense (other than minor traffic violations)?
*
Yes
No
If yes, please explain.
Are there any criminal or traffic charges pending against you?
*
Yes
No
If yes, please explain.
Has your name been entered on the Community Services Worker Registry that is maintained by OK DHSDDS?
*
Yes
No
Do you have any reason to believe you name will appear on this registry in the future?
*
Yes
No
Is any additional information relative to a change of name or the use of an assumed name or nickname necessary to enable a check on your previous work record?
*
Yes
No
If yes, please explain.
Have you ever applied to this company before?
*
Yes
No
If yes, where and when?
Have you ever worked for this company under a different name?
*
Yes
No
If yes, please explain.
Do you know anyone currently working for this company?
*
Yes
No
Are you authorized to work in the U.S.?
*
Yes
No
(CSCSO will verify your eligibility to work in the United States via participation in the DHS/SSA E-Verify program.)
What language(s) do you speak fluently?
Have you or do you serve in the U.S. Armed Forces or in the National Guard?
*
Yes
No
If yes, please describe the experience.
Employment Desired
Position
Date available to start
Month
Day
Year
Are you currently employed?
*
Yes
No
If yes, may we enquire of your present employer?
*
Yes
No
Educational Background
High School Name
*
Location
*
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Did you graduate?
*
Yes
No
If no, do you have a GED?
Yes
No
Trade or Business School Name
Location
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Did you graduate?
Yes
No
Area of Study or Major
College or University
Location
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Did you graduate?
Yes
No
Area of Study or Major
Personal References & Emergency Contact
List the name and phone number of at least three people you feel would be willing to provide a personal reference for you.
#1 Contact Name
*
First
Last
Phone
*
Relationship
*
Years Known
*
Less Than 1 Year
1-3 Years
4-6 Years
7+ Years
#2 Contact Name
*
First
Last
Phone
*
Relationship
*
Years Known
*
Less Than 1 Year
1-3 Years
4-6 Years
7+ Years
Emergency Contact Name
*
First
Last
Relationship
*
Phone
*
By State policy, we are required to verify your employment with all former employers. Please thoroughly read and complete the attached Employment Application Supplement. Failure to comply could affect your status in the position selection process.
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed to give you all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and the release of all parties from all liability for any damage that may result from furnishing same to you. Per State policy, I acknowledge that I have received for my information a copy of the DDS 59 (Rights and Responsibilties of Community Service Worker in an Investigation of Maltreatment). I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.
Signature
*
(Typed name will serve as electronic signature)
Date
*
Month
Day
Year
Δ
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