OKLAHOMA DEPARTMENT OF LABOR
An equal opportunity employer
Application for Employment
OKDOL issued 7-1-2007 Page 1 of 5
Please print or type all information on this form. Answer each question fully and accurately.
If you need additional space, continue in section 19 or attach supplemental information
identifying the section by question number for which you are inserting information.
Unsigned and undated applications cannot be processed. Return this form to the office
you obtained it from, unless otherwise instructed.
1. Last name
First name
Initial
Suffix
Social Security number
Mailing address
City
State
Zip code
E-mail address
Home phone
Business phone
Extension
Finding address
City
State
Zip code
2. Are you legally allowed to work in the United States? Yes No
Work permit number:
3. Are you currently a resident of Oklahoma? Yes No
4. Are you applying for temporary work? Yes No
5. Have you ever pled guilty, no contest, or been found guilty
of any offense other than minor traffic violations? Yes No
If yes, in section 19 provide additional information regarding date(s),
location(s), type(s) of offense(s).
Have you had a final protective order entered against you pursuant to the
Oklahoma Protection from Domestic Abuse Act or a similar statute
of another state? Yes No
If yes, in section 19 provide the name of the court and court number.
6. Have you been discharged or resigned in lieu of discharge
from employment? Yes No
If yes, in section 19 provide all pertinent information relating to this termination.
7. If you have worked under another name(s) please list the full name(s) in section 19.
8. Date you will be available for employment:
Application for Employment
Page 2 of 5 ODOL issued 7-1-2007
9. Education:
Name of school
or special
training received
Location
city and state
Month/
Year
to-from
Graduate
Yes / No
Major Type of
degree or
diploma
If the position for which you are applying requires college course work, please attach
a copy of your transcript. The transcript will become a permanent part of your records and
will not be returned.
10. Special qualification: Typing (WPM): Manual sign language
Personal computer skills: Beginner Intermediate Advanced
Bilingual skilled, indicate language other than English:
11. Software skills: Excel Access Other (Specify):
Internet technologies: Yes No
12. Do you have a valid driver’s license? Yes No License no:
Issuing state: Expiration date:
13. Do you have access to transportation for job-related travel? Yes No
14. Specialized licenses/certification. Kind:
Year first received: Year last received:
State or other licensing authority:
15. Employment history. List the last five years of your employment history or all work
experience, whichever is greater, that relates to the position you are seeking.
IMPORTANT. Please list all periods of your employment history separately,
starting with your present employer. If you have more than four separate periods
of employment, attach a sheet of paper listing all employment information in the
same outline form as below. Also, if you performed different jobs at one location, list
each job as a separate period of employment. Date and sign each attachment.
May we contact your present employer? Yes No
Have you ever worked for the Oklahoma Department
of Labor (ODOL)? Yes No
Have you ever worked for any other Oklahoma state agency? Yes No
If yes, list agency(s) and date(s):
Application for Employment
ODOL issued 7-1-2007 Page 3 of 5
Employer’s name
Title of position
Address
Employment dates (mo./yr. to mo./yr.)
Job duties: Be specific. Attach extra sheets, dated
and signed, if necessary.
Average hours worked per week
Reason for leaving
Beginning salary
Ending salary
Name of supervisor
Supervisor title and phone
Did you supervise any employees?
Yes No
If yes, list number and general duties of employees.
Employer’s name
Title of position
Address
Employment dates (mo./yr. to mo./yr.)
Job duties: Be specific. Attach extra sheets, dated
and signed, if necessary.
Average hours worked per week
Reason for leaving
Beginning salary
Ending salary
Name of supervisor
Supervisor title and phone
Did you supervise any employees?
Yes No
If yes, list number and general duties of employees.
Employer’s name
Title of position
Address
Employment dates (mo./yr. to mo./yr.)
Job duties: Be specific. Attach extra sheets, dated
and signed, if necessary.
Average hours worked per week
Reason for leaving
Beginning salary
Ending salary
Name of supervisor
Supervisor title and phone
Did you supervise any employees? If yes, list number and general duties of employees.
Yes No
Application for Employment
Page 4 of 5 ODOL issued 7-1-2007
Employer’s name
Title of position
Address
Employment dates (mo./yr. to mo./yr.)
Job duties: Be specific. Attach extra sheets, dated
and signed, if necessary.
Average hours worked per week
Reason for leaving
Beginning salary
Ending salary
Name of supervisor
Supervisor title and phone
Did you supervise any employees?
Yes No
If yes, list number and general duties of employees.
16. Position. Indicate the position for which you are applying.
Job classification:
I will accept this job under the following conditions. When both blocks in any
category are left blank, NO will be assumed:
Full-time: Yes No Temporary (Six months or less): Yes No
Part-time: Yes No Frequent travel: Yes No
Shiftwork: Yes No
Some jobs require employees to be on-call on a regular, scheduled basis. Please
indicate whether you will accept an appointment with on-call requirements. Yes No
ODOL policy does not prohibit employment of relatives; although relatives may not
work together in the same division within the Agency. Therefore, please list the
names of your relatives, first cousins, or nearer, by blood, adoption and/or
marriage, now employed by ODOL.
Name
Relationship
Location of employment
Name
Relationship
Location of employment
Name
Relationship
Location of employment
Name
Relationship
Location of employment
17. How did you learn about employment with ODOL?
Application for Employment
ODOL issued 7-1-2007 Page 5 of 5
18. Job-related references. List name, address, and telephone number:
19. Use this space for any additional information, comments, or explanations you may
have that are relative to your application. If you are providing additional information for
a certain section on this form, please list that section and question number. Attach
additional sheets, signed and dated, if needed.
Please read the following information carefully and sign and date below.
Accuracy of information: I have reviewed and made sure all sections are correct
and complete. I understand that my eligibility for employment will be based on the
information I have given on this application.
Falsification of information: I certify that all statements made on this application
are true and correct. I understand that any false statement made by me may cause
me to be ineligible for employment or subject to termination from employment. I also
understand that Section 365(B) of Title 21 of the Oklahoma Statutes prohibits
applicants for state employment from making a materially false, fictitious, or
fraudulent statement or representation on an employment application, knowing such
statement or representation to be materially false, fictitious, or fraudulent. Violation is
a criminal offence, punishable by fine and/or imprisonment.
Verification of information: I authorize ODOL to investigate and verify the facts
claimed by me on this application. I also authorize my former employers and job-related
references to provide any information requested by ODOL.
Return this application to the address listed on the front of this form. Unsigned and
undated applications will not be processed.
Effective July 1, 2007, some applicants for employment with ODOL receiving a
conditional offer of employment must pass an alcohol and drug test pursuant to the
alcohol and drug testing policy of ODOL.
Signature Date
