Hominy Public Schools

Please Fill Out The Support Staff Application Below

Date

Name

Address

City

State

Zip

Home Phone Number

Work Phone Number

Email Address

Are you 18 years of age or older

Yes

Are you legally eligible for employment in the United States? (Proof of eligibility will be required prior to employment.)

Yes

Are you related to anyone employed by or a board member of Hominy Public Schools?

If yes, Please list the name and relation of all relatives who work for Hominy Public Schools.

Position Applied For

Cafeteria

Custodial

Clerical

Bus Driver

Teachers Aide

Other

Name of Present Employer or Most Recent

Address: City, State, Zip

Employer's Phone

May communicate with present employer?

Reaquired field: Yes

Reaquired field: No

Name and Title of Supervisor

Your Current Title

Employed From-To Dates

Describe Your Duties

Reason for Leaving

Name of Last Employer

Address: City, State, Zip *

Employers Phone

Name and Title of Supervisor

Employed From-To Dates

Describe your Duties

Reason for Leaving

Name of Last Employer

Address: City, State, Zip

Employer's Phone

Name and Title of Supervisor

Employed From-To Dates

Describe your Duties

Reason for Leaving

Name of Last Employer

Address: City, State, Zip

Employer's Phone

Name and Title of Supervisor

Employed From-To Dates

Describe your Duties

Reason for Leaving

High School Attended

Year Graduated

College or University Attended

Dates of Attendance

Major Field of Study

Minor Field of Study

Type of Degree

Year Earned

Have you ever failed to be reemployed?

Where?

If yes, please explain

Why do you wish to leave your present position?

On what date will you be available if offered employment at "School Name"?

Have you ever entered a plea of guilty or nolo contendre to a state (any state) or federal charge? (This question includes criminal cases involving a "deferred sentence." "deferred judgement" and any "expunge of the records.")

Reaquired field: Yes

Reaquired field: No

Have you ever been convicted of a state (any state) or federal felony offense?

Reaquired field: Yes

Reaquired field: No

Have you ever been charged with a state (any state) or federal felony offense, which was reduced to a misdemeanor offense to which you entered a plea of guilty or nolo contendere? (This question includes criminal cases involving a "deferred sentence," "deferred judgement" and any "expunge of the records.")

Reaquired field: Yes

Reaquired field: No

Have you ever entered a plea of guilty or nolo contendere to, or been convicted of a state (any state) or federal misdemeanor charge involving illegal chemical substance or illegal sexual activity? (This question includes criminal cases involving a "deferred sentence," "deferred judgement" and any "expunge of the records.")

Reaquired field: Yes

Reaquired field: No

Have you ever entered into a deferred prosecution agreement with a state (any state) or federal prosecutor?

Reaquired field: Yes

Reaquired field: No

Have you ever been required to register as a sex offender under the Oklahoma Sex Offender Registration Act or under similar laws in another state?

Reaquired field: Yes

Reaquired field: No

Did you serve in the military

Yes

If yes, what branch of service?

Date Entered

Rank at Discharge

Type of discharge or separation

Date

Major Duties

Service Schools Attended

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Upload Cover Letter (optional)

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I understand that my application will remain active for one year and that I should notify Hominy Public Schools, in writing, if I wish to be considered beyond that period. All persons, firms, and entities listed in this application are hereby authorized to release any information or records concerning me to the personnel department of Hominy Public Schools and I hereby release said persons, firms, and entities from any liability as a result of the furnishing of such records and information. I certify to the best of my knowledge the facts set forth in my application are accurate and complete. I understand that falsifying information on this application will result in non-employment or, after employment or discharge.

Signature (By typing your name, you agree that this is valid as your signature.)

Date

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