OPC

PLEASE FILL OUT THE ENTIRE APPLICATION COMPLETELY. PLEASE ENSURE YOU ARE PROVIDING CORRECT

TELEPHONE NUMBERS, AND DO NOT LIST RELATIVES AS REFERENCES. THANK YOU!

How did you hear about us?

First Name

MI

Last

Date of Birth

Date

SSN#

Present Address

Street/PO Box

City

State

Zip

How long at above address?

Telephone#

Alt Telephone #

Email

example@example.com

In case of emergency, please contact: (Full Name)

Relationship

Emergency Phone Number

What position are you applying for?

Would you consider other positions?

Have you previously worked for OPC?

Date available to start work? (MM/DD/YYYY)

Date

What are you applying for?

Full TimePart Time

Are you available to work nights?

Saturdays or Sundays?

Irregular shifts?

Holidays?

Travel?

12 Hour Shifts?

Overnight Shifts?

Lifting is an essential duty for certain positions at OPC. Do you have any lifting restrictions?

Will you consent to release your police Records if any on file?

Have you been convicted of a crime?

Name of High School & Location

College Name & Location

Business, Professional or Trade School name & location

If completed what type of certification/license?

Do you have a valid drivers license?

Do you have your own transportation?

Have you had any accidents in the past three years?

How Many?

Name of Employer

Address

State

ZIP

Phone Number

Pay

Last Job Title

Reason for Leaving

Name of Employer

Address

State

ZIP

Phone Number

Pay

Last Job Title

Reason for Leaving

List the top three duties for which you were responsible

Name of Employer

Address

State

ZIP

Phone Number

Pay

Last Job Title

Reason for Leaving

List the top three duties for which you were responsible

Note: Please list three personal references (excluding relatives) complete with name and telephone numbers for individuals you have known for at least one year. Reference #1

Name:

Phone:

Name:

Phone:

Name:

Phone:

As an indication that you have read and understood each sentence, please sign in the box provided below.

In exchange for the consideration of my employment application by OPC (or also referred to as "Agency"), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents, employee handbooks, personnel manuals, policy statements, and the like as they may exist from time to time, or other agency practices, shall serve to create an actual or implied contract of employment , Or to confer any right to remain a OPC employee, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned,and that the relationship cannot be altered except by a written instrument signed by the Executive Director of the agency Both the undersigned and OPC may end the employment relationship at any time without specified notice or reason.

If employed, I understand the Agency may unilaterally change, reduce, or revise their benefits, policies and proceduresI understand that as an employee of OPC, my position, schedule or job title may change to better fit the needs of OPC and the clients they serve

I authorize investigation of all statements contained in this applicationand any other requested background information. I understand the misrepresentation, falsification, or omission of facts is cause for termination at any time without previous notice hereby give the Agency permission to contact schools, all previous employers (unless otherwise indicated), references, conduct required background checks, and others, and hereby release the Agency from any liability as a result of such contact

I further understand that my employment with the agency shall be probationary for a period of (60) days, and further that at any time during the probationary period or thereafter, my employment relationship with the agency is terminable at will for any reason by any party

Initial here

Clear

Signature of Applicant

Clear

Date

Thank you for completing the application and for your interest at Oklahoma Production Center.

OPC

Work History

Personal References

Acknowledgements