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Support Application
Last Name:
Middle name:
First Name:
Present Address:
Phone No.:
State:
City:
Street:
Zip:
Permanent address:
How long at this address?
Date of Birth:
Race:
Social Security Number:
U. S. Citizen? Yes    No
Legal alien? Yes    No
Have you ever been employed here?
   When?
   Location:
Names of relatives or friends working here 
Referred by 
Friend:
Relative:
In case of emergency, notify:
Relationship:
Address:
City:
State:
Phone:
Have you ever been charged or convicted of a felony? Yes    No
If above answer is YES explain
Do you have any physical impairment that would interfere with your performance in the position for which you are applying? 
Position(s) desired:
Date Available:
LIST NAMES OF TWO REFERENCES (Not Relatives) TO WHOM WE MAY REFER
Name Occupation Address
EDUCATION
  Name & Location of School No. Yrs Attended Date Graduated Type of Course
Elem. School`
High School
College
Trade Or Bus. School
Employment History Cover at least last five years
Name & Address Of Employer/Supervisor Date Month & Year Position Salary Reason for Leaving
  From: To:      
MILITARY SERVICE
Branch of Service:
Entered:
Discharged:
Type of Discharge:
Rank:
Present membership in National Guard:
Reserves:
Unit:
Explain National Guard or Reserve Commitment:
Which is your present Selective Service Classification?
Have you ever worked with children?
   If so, where:

Check type of position for which you are qualified:
Secretary General Maintenance Cook Teacher Assistant
Custodian Cafeteria Assistant Library Assistant Cook Manager Bus Driver
Other:
Answer the following questions if applying for a Transportation Position.
Otherwise, proceed to the Agreement Section.
Have you ever driven a (type of vehicle) 
If so, where? 
How many years? 

What other driving experience have you had?  (give years experience)
Car:
Truck:
Other:
Do you have a drivers license?  
Expiration Date 
Drivers License Number 
Bus Driver Permit Number 
Do you have a CDL? 
CDL Number 
1801 McKenzie Pawhuska • OK 74056
Tel: (918) 287-1265 • Fax: (918) 287-4461

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