Application For Employment

City of Sapulpa 425 East Dewey Sapulpa, OK 74066

We consider applicants for all positions without regard to race,

color, religion, creed, gender, national origin, age, disability, marital

or veteran status, sexual orientation, or any other legally protected status.

(Please Print)

Position Applied For		Date of Application
How Did You Learn About Us?
Advertisement	Friend		Walk-In
Employment Agency	Relative		Other

Last Name	First Name			Middle Name
Address Number Street		City	State			Zip Code
Telephone Number (s)					Social Security Number

If you are under 18 years of age, can you provide required proof of your eligibility to work?					Yes		No
Have you ever filed an application with us before?			If yes, give date:		Yes		No
Have you ever been employed with us before?			If yes, give date:		Yes		No
Are you currently employed?					Yes		No
May we contact your present employer?					Yes		No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.					Yes		No
Are you available to work:	Full Time	Part - Time		Shift Work		Temporary
Are you currently on “lay-off” status and subject to recall?					Yes		No
Do you have a current valid driver’s license?					Yes		No
Have you been accused of a crime within the last 7 years? Conviction will not necessary disqualify an applicant from employment.					Yes		No
If yes, explain:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Education

	Name and Address Of School	Course of Study	Years Completed	Diploma Degree
Elementary School
High School
Undergraduate College
Graduate Professional
Other (Specify)

Specialized Skills Circle