ࡱ>   bjbjAA }++#,44$P<>B%T*****qqq$$$$$$$$'H*`$9|q$**$N N N F**$N $N N ""*pSp2j"$%0B%",**""0*#qrN \ qqq$$qqqB%*qqqqqqqqq4 T:  WESTERN OKLAHOMA STATE COLLEGE Application for Employment 2801 North Main St. Altus, OK 73521; (580) 477-2000 EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER The COLLEGE does not discriminate on the basis of race, color, religion, sex, national origin, age, marital or veteran status, political affiliation, disabled status or any other legally protected status. Print or type answers to each question clearly and completely. All questions must be answered. This is an application for employment and no employment contract is being offered. The COLLEGE may change wages, benefits and conditions of employment at any time. If you need assistance in completing this application form, please inform the receptionist. Position desired Social Security No. . Date of application Date available for work .  Are you available to work Full-time Part-time Shift work Weekends Nights If part-time what hours and days: Last Name First Middle  Street address Home Phone  City, State, Zip Business Phone  If you are under 18 years of age, can you provide proof of your eligibility to work? Yes No Have you ever worked for the College? Yes No If yes, give prior name, dates and reason for leaving:  Are you legally eligible to work in the United States? Yes No (Verification will be required upon employment and failure to furnish will be cause for separation.) Do you hold a current and valid Oklahoma operators or commercial chauffeur drivers license? Yes No (If so, give type, expiration date and number: ) (If tentatively selected, applicants applying for a position where driving is required, will be required to furnish a copy of their driving record at their expense prior to employment.) Military Service: Branch Date entered . Date and type of discharge . Indicate specific military experience or training that is job related: _________________________ ________________________________________________________________________________________________  After reviewing the essential job functions from the attached job description/posting, are you able to do them with or without reasonable accommodation? Yes No The COLLEGE is concerned with your ability to perform the job and will not at this time consider your need for reasonable accommodation. If after reviewing your application form, verifying your responses, and conducting necessary interviews or tests, you are considered for the job and would need reasonable accommodation to perform the essential job functions, the parties will explore these alternatives. REMEMBER: The COLLEGE may conduct a pre-employment exam, which will determine whether you can do the essential functions of the job without substantial risk to yourself and the public. In addition, review the attached minimum qualifications and provide us with prior education, work experience, and any relevant training or certificates and licenses that would indicate your knowledge, skills, and abilities to perform the job. Be as specific as possible since you will be screened on what you include regardless of what you might otherwise be able to perform. EDUCATIONAL RECORD School Name and Address of School Course of Study Check Last Year Completed Did you Graduate List Diploma or Degree Middle    567 8 Yes No       High/GED    1 2 3 4 Yes No       College    1 2 3 4 Yes No       Other       Give name, address and telephone number of three references who are not related to you and are not previous employers. Name: Address: Telephone No:  Name:  Address: Telephone No: Name: Address: Telephone No:  MP EMPLOYMENT EXPERIENCE 1. Employer, Address Date Started To Work performed      Job Title: Hourly Rate/Salary Starting Hourly Rate/Salary Final    Supervisor:  Reason for leaving:  2. Employer, Address Date Started To Work performed      Job Title: Hourly Rate/Salary Starting Hourly Rate/Salary Final    Supervisor:  Reason for leaving:  3. Employer, Address Date Started To Work performed      Job Title: Hourly Rate/Salary Starting Hourly Rate/Salary Final    Supervisor:  Reason for leaving:  4. Employer, Address Date Started To Work performed      Job Title: Hourly Rate/Salary Starting Hourly Rate/Salary Final    Supervisor:  Reason for leaving:  If you need additional space, please continue on a separate sheet of paper. ADDITIONAL INFORMATION If you have any additional information or comments concerning any voluntary experience, any special licenses or training which would help us determine your suitability for this position, please use the space provided below or an extra sheet of paper if necessary. All attachments must be signed.    Read Carefully Before Signing I certify that facts given in this application are true and complete to the best of my knowledge. I hereby grant permission to the COLLEGE to investigate any information included in the application and I agree to submit to medical examination if required. I understand that this application is not a contract of employment. I hereby release the COLLEGE and its agents from all liability in making any investigation and inquiry relative to information contained in the application form. I understand that if employed, false or misleading statements given in this application or interview(s) may result in discharge. I understand that I am required to abide by all rules and regulations of the COLLEGE. Employment at WOSC is at will and therefore is not guaranteed and may be terminated at any time by the employee or the employer without notice, reason or cause. Signature of Applicant Date w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w Do not write below this line For Office Use Only: This section to be completed by interviewer before application is returned to Personnel. Applications screened and most qualified tested/interviewed. Interviewed by Date: . Remarks: References and prior work history checked: Yes No Remarks: Recommended for Hire by Supervisor: Yes No Concurrence of Personnel Selection Committee: Yes No Supplemental Questionnaire for Information Technology Applications Describe your experience maintaining and troubleshooting Microsoft Windows operating systems and other Microsoft products (Server 2003, XP, Exchange, Office Products). Provide specific examples including your role and level of responsibility. (No more than 1 page) Describe your experience working as part of a technical team that implemented a tech project for a single department or division. Use example(s) in your description and be specific about your role, level of responsibility and the project scope. (No more than 1 page) Describe your experience working with networking technologies including wireless technology. Be specific in your response: identify the environment, application, your role and level of responsibility. (No more than 1 page) Describe your experience with installing, maintaining and troubleshooting software and enterprise applications. Provide specific examples, including your role and level of responsibility. 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