Employment Application

205 South J.T. Stites Boulevard
Sallisaw, Oklahoma 74955
(918) 775-7787
(800) 318-6866

PLEASE COMPLETE THE ENTIRE APPLICATION COMPLETELY. PLEASE ENSURE YOU ARE FURNISHING CORRECT TELEPHONE NUMBERS, AND DO NOT LIST RELATIVES AS REFERENCES. THANK YOU!

Note: This is an application for employment for People Inc, located in Sallisaw, Oklahoma.
This is NOT for employment for a company with the same name that resides in New York.


  HOW DID YOU HEAR ABOUT US?
 PERSONAL INFORMATION
First: MI: Last:
SSN# - -
Present Address:
Street/PO Box City State Zip
How long at above address? Telephone #:
Alt Telephone #:
OTHER INFORMATION
If emergency, please contact: (Full Name) Relationship
Emergency Phone Number:
What position are you applying for within People Inc.?
Would you consider any other positions within People Inc.? If yes, please list
Have you previously worked for People Inc.?
If yes, please list dates of employment, dept. and/or supervisor’s name. (200 Characters or Less)
Are you over 18?                       Are you over 21?                       U.S. Citizen?
Date available to start work? (mm/dd/yyyy)
What are you applying for:                       How many hours/week?
WORK AVAILABILITY AND BACKGROUND INFO
Are you available to work: Nights?        Saturdays or Sundays        Irregular shifts?
Holidays?           Travel?           12-Hour Shifts?           Overnight shifts?
Lifting is an essential duty for certain positions at People Incorporated. Do you have any lifting restrictions?
If you answered yes to the lifting restriction, please list
Will you consent to release your police records, if any on file?
Have you ever been convicted of a crime? If yes, please indicate nature of conviction and date:
NOTE: Conviction of a crime will not automatically disqualify you from employment. Other factors such as date of offense, seriousness, and nature of the violation, as well as rehabilitation will be taken into account. As required in DDSD policy CAC 340; 100-3-39, please provide us with information regarding any allegation of abuse, neglect, or exploitation, which were reported to APS or OCA.
EDUCATIONAL EXPERIENCE:
Please select the highest grade completed: 9 10 11 12
Have Received Diploma or GED? IF Attended, Name of High School & Location:
College Name & Location: Degree Completed? Major/Minor:
Business, Professional or Trade School Name & Location: Completed?
If completed, what type of certification/license?
DRIVING EXPERIENCE:
Do you have a valid driver’s license? Do you have your own transportation?
Have you had any accidents during the past three years? How many?
Have you had any moving violations during these past three years? How many?
OFFICE/CLERICAL EXPERIENCE:
Please list all PC experience (software and years of experience) (200 Characters or Less):
MEDICAL/COUNSELING EXPERIENCE:
Please list license/date obtained/experience: (200 Characters or Less):
MILITARY EXPERIENCE:
Have you ever been in the armed forces? Are you now a member of the National Guard?
Specialty/Skills: Date Entered (mm/dd/yyyy):
Discharge Date (mm/dd/yyyy): Rank upon Discharge:
Type of Discharge::
WORK EXPERIENCE:
NOTE: Please list your work experience for the past seven years beginning with your most recent job. If you were self-employed, give company name and supply copy of most recent corporate incorporation papers from state or corporate tax return.

Name of Employer/Address/City/State/Phone Number: (250 Characters or Less)
Name of Last Supervisor:
Employment Dates: From    To
Pay: Last Job Title:
Reason for Leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
(400 Characters or Less)


Name of Employer/Address/City/State/Phone Number: (250 Characters or Less)
Name of Last Supervisor:
Employment Dates: From To
Pay: Last Job Title:
Reason for Leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
(400 Characters or Less)


Name of Employer/Address/City/State/Phone Number: (250 Characters or Less)
Name of Last Supervisor:
Employment Dates: From To
Pay: Last Job Title:
Reason for Leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
(400 Characters or Less)
REFERENCES:
NOTE: Please list four personal references (excluding relatives) complete with name and telephone number(s).
Reference #1: Name: Phone:

Reference #2: Name: Phone:

Reference #3: Name: Phone:

Reference #4: Name: Phone:

APPLICATION FORM WAIVER:
May we contact your present employer?

Please inital As indication that you have read and understood each sentence, please type your First, Middle and Last initials in the spaces provided below.

In exchange for the consideration of my employment application by People Incorporated, (or also referred to as “Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents, employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment . Or to confer any right to remain a People Incorporated employee, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the CEO of the Company . Both the undersigned and People Incorporated may end the employment relationship at any time without specified notice or reason . If employed, I understand the Company may unilaterally change, reduce, or revise their benefits, policies, and procedures .

I authorize investigation of all statements contained in this application and any other requested background information. I understand the misrepresentation, falsification, or omission of facts called for is cause for termination at any time without previous notice . I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references, conduct required background checks, and others, and hereby release the Company from any liability as a result of such contact .

I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by any party .



Signature of Applicant        Date: 10.19.2017
If you are interviewed, you will sign the waiver and application at that time.




Thank you for completing the application and for your interest in People Incorporated.