Secure Application for Employment
Human Resources Department
3349 South Highway 181
Kenedy, Texas 78119
This organization complies with all federal, state and local equal Employment opportunity laws and guidelines.
http://www.okmh.org
email: 
Date
PLEASE COMPLETE ALL ITEMS. ENTER N/A IF ITEM DOES NOT APPLY TO YOU
Last Name                                    First Name                                  Middle Initial
   
Date Available:


Home Phone

Cell Phone

Present Address

Present City

Present State

Present Zip Code

E-Mail Address

Current Open Position(s) for Which You Are Applying



Type of Position
Per Diem
Pool
Full Time
PRN
Part Time
Temporary
Shift

Weekend
Day
Night
Evening
Rotation
Why Do You Choose Hospital Work?
What Prompted You to Apply Here for Employment?
Are you related to any current employee? Who and How?
Hobbies:
How did you learn about this position?
State Employment
         Commission
Internet
Agency
Ad
Job Listing
School
Current Employee
Job Line
Other:

IN CASE OF EMERGENCY NOTIFY:
Name:   Relationship:
Have you been convicted of a felony within the last 10 years?
If so, what was the conviction?

Where?
City:   State:

Do you have any moving violations or accidents on your driving record?
Educational History
Type of School
Name of School

City, State
Check Last Year
Attended in School

Degree or Certificate
High School
School:
    City:
   State:
9   10   11   12
Graduated/GED?
Degree:
College
School:
    City:
   State:
1     2     3    4
Graduated?
Degree:
College
School:
    City:
   State:
1    2    3     4
Graduated?
Degree:
Graduate
School

School:
    City:
   State:
1    2     3    4
Graduated?
Degree:
Other
School:
    City:
   State:
1    2    3    4
Graduated?
Degree:
Other
School:
    City:
   State:
1    2    3    4
Graduated?
Degree:
List any professional licenses, registration or certification you possess
(Include Driver's License, if applicable)
Include Type, State Issued, Expiration Date and Number.
Indicate if any licenses have been revoked, suspended or placed on probation.
Also indicate if you are ineligible to become licensed or certified in your field. Please explain.

Clerical or other skills applicable to the position for which you are applying
Typing (WPM)              PBX
Proficient in Software: 
Business machines and/or equipment you can operate:
      
Other