City of Sapulpa Logo

PERSONAL INFORMATION

First Name*  Middle Name*  Last Name* 

Address1* 

Address2  

City*  State*  Zip* 

Phone Number* (XXX-XXX-XXXX)  Email Address* 

Are you eligible to work in the United States?* YesNo

POSITION INFORMATION

Desired position:* 

Type of Employment Desired* Full-TimePart-TimeSeasonal   Hours of work (per week) desired* 

How did you hear about the position? Please provide name of current employee, if applicable.*

EDUCATION

High School  Address 

College  Address 

 Degree 

Other  Address 

 Degree 

EMPLOYMENT HISTORY 

(From Most Recent)

Company  Position 

Supervisor  Phone 

May we contact your previous supervisor for a reference? YesNo

Address 

Responsibilities

Employed From - To (Date)    

Company  Position 

Supervisor  Phone 

May we contact your previous supervisor for a reference? YesNo

Address 

Responsibilities

Employed From - To (Date) 

Company  Position 

Supervisor  Phone 

May we contact your previous supervisor for a reference? YesNo

Address 

Responsibilities

Employed From - To (Date)  

REFERENCES

Please list three professional references. 

Full Name*  Relationship* 

Company*  Phone Number* 

Full Name*  Relationship* 

Company*  Phone Number* 

Full Name*  Relationship* 

Company*  Phone Number* 

DISCLAIMER & SIGNATURE

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information. I have read the job description provided and can perform the essential functions of the position with or without accommodations.

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status.

We are an Equal Opportunity Employer.

Applicant Signature*