Job Application

353 East A Street, Atoka, OK 74525

City of Atoka Employment Application

The City of Atoka is an Equal Opportunity Employer committed to excellence. Employment offers are made on the basis of qualifications, without regard to race, creed, color, gender, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Position Applying For

Name (Last, First, Middle)

Other Names or Aliases

Street Address

Date of Birth

Social Security Number

Phone

City, State, ZIP

Email Address

Are you a Citizen Of the United States? If not, are you authorized to work in the United States? Y/N

Are you currently employed? If yes, what date are you available for work?

Have you ever been employed by the City of Atoka? If yes, please list the dates you were employed and reason for leaving.

Are you related to any City of Atoka employee? If yes, list their name and relationship to you.

If required, do you have a valid driver's license? If yes, please list state, license # and expiration date.

Do you have a valid commercial driver's license (CDL)? If yes, please list state, license #, expiration date and class.

Are you bondable? Y/N

Have you ever been convicted of a felony or misdemeanor? If yes, please explain.

How did you learn about this employment opportunity?

Education

High School

City, State

Did you graduate? Y/N

Degree received?

GED

City, State

Did you graduate? Y/N

Degree received?

College/University

City, State

Did you graduate? Y/N

Degree received?

Major?

Other

City, State

Did you graduate? Y/N

Degree received?

Major?

Other credentials, licenses, professional affiliations, etc., which are relevant to the position(s) to which you are applying:

Skills

Please list any technical, clerical, and/or trade skills, etc., relevant to this position. Include any relevant computer systems and software applications/packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, or expert).

Work Experience

Please detail your work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Omission of prior employment may be considered falisification of information. Please explain any gaps in employment. include full-time military or volunteer commitments. PLEASE NOTE: The City of Atoka reserves the right to contact all current and former employers for reference information.

Dates Employed (most recent position):

Full-time/Part-time?

Title:

Salary (starting & final):

Organization Name:

Supervisor Name & Title:

Phone Number:

Primary Duties:

Contact references at any time or only if you are a finalist?

Reason for leaving?

Dates Employed:

Full-time/Part-time?

Title:

Salary (starting & final):

Organization Name:

Supervisor Name & Title:

Phone Number:

Primary Duties:

Contact references at any time or only if you are a finalist?

Reason for leaving?

References

Please list three personal or professional references, These references cannot be listed anywhere else on this application.

Name:

Relationship:

Years Known:

Phone Number:

Name:

Relationship:

Years Known:

Phone Number:

Name:

Relationship:

Years Known:

Phone Number:

Please read carefully. By Pressing submit you are acknowledging that you understand and accept this information.

I certify that the information on this application and its supporting documents is full, complete, truthful and accurate. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize the City of Atoka to investigate, without liability, all statements contained in the application and supporting materials. I authorized references and former employers without liability, all statements contained in this application and supporting materials. I authorized references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that employees of the City of Atoka serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If I am offered a conditional offer of employment, I will be required to furnish proof of eligibility to work in the United States and to comply with city and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.

ROUTINE RECORD CHECK

BY PRESSING SUBMIT, I DO HEREBY GRANT PERMISSION FOR THE CITY OF ATOKA TO DO A ROUTINE RECORD CHECK. I UNDERSTAND THAT A DECISION CONCERNING MY EMPLOYMENT WITH THE CITY OF ATOKA MAY BE BASED ON INFORMATION PROVIDED IN THIS RECORD CHECK.

Date of Birth:

Social Security Number:

Your application has been received!

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353 East A Street
Atoka, Oklahoma 74525

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580-889-3341

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