JOB APPLICATION
Muscogee Staffing Solution
1018 S Wood Dr, Okmulgee, Oklahoma 74447 918-752-3152
Muscogee Staffing Solution is an equal opportunity employer. This application will not be used for
limiting or excluding any applicant from consideration for employment on a basis prohibited by
local, state, or federal law. Should an applicant need reasonable accommodation in the application
process, he or she should contact a company representative.
Please fill out all of the sections below:
Applicant Information
Applicant Name: ___________________________________
Address: __________________________________________
City, State and Zip___________________________________
Area Code:________ Telephone Number:______________ Email Address:______________________
Date of Application: _________________________
Employment Position
Position(s) applying for: (full time)_________________________________
How did you hear about this position?_____________________________
What days are you available for work?_____________________________
What hours or shift are you available for work? ______________________
If needed, are you available to work overtime? ___________________
On what date can you start working if you are hired?__________________
Do you have reliable transportation to and from work?_________________
Salary desired: _____________________
Personal Information
Have you ever applied to or worked for Muscogee Staffing Solution
before? Yes No
If yes, when?______________________
Are you 18 years of age or older? Yes No
Are you a U.S. citizen or approved to work in the United States? Yes No
What document can you provide as proof of citizenship or legal status?______________________________
Will you consent to a mandatory controlled substance test? Yes No
Do you have any condition which would require job accommodations? Yes No
If yes, please describe accommodations required below.
_________________________________________________
Have you ever been convicted of a criminal offense (felony or
misdemeanor)? Yes No
If yes, please state the nature of the crime(s), when and where convicted and disposition of the
case:______________________________________________________________________
Job Skills/Qualifications
Please list below the skills and qualifications you possess for the position for which you are
applying:__________________________________________________________________
_________________________________________________________________________
(Note: Muscogee Staffing Solution complies with the ADA and considers reasonable accommodation
measures that may be necessary for eligible applicants/employees to perform essential functions. )
Education and Training
High School
Name __________________________
Location (City, State)___________________
Year Graduated __________________
Degree Earned___________________
College/University_________________
Name _________________
Location (City, State)________________
Year Graduated_______________
Degree Earned_______________
Vocational School/Specialized Training
Name _________________
Location (City, State)_______________
Year Graduated___________________
Degree Earned___________________
Military:
Are you a member of the Armed Services?_________________
What branch of the military did you enlist?_________________
What was your military rank when discharged?_____________
How many years did you serve in the military?______________
What military skills do you possess that would be an asset for this position?____________________________
Previous Employment
Employer Name: _______________________
Job Title_______________
Supervisor Name:_______________
Employer Address____________________: City, State and Zip Code:_____________________ Employer Telephone:_______________
Dates Employed:____________________
Reason for leaving: __________________
Employer Name: ________________________
Job Title:_______________
Supervisor Name:_________________
Employer Address: _______________
City, State and Zip Code:____________________
Employer Telephone: _______________________
Dates Employed: _________________
Reason for leaving:_______________________
Employer Name: ________________________
Job Title:________________________________
Supervisor Name:________________________
Employer Address:________________________
City, State and Zip Code:___________________
Employer Telephone:______________________
Dates Employed:_________________________
Reason for leaving:_______________________
AT-WILL EMPLOYMENT
The relationship between you and the Muscogee Staffing Solution is referred to as "employment at
will." This means that your employment can be terminated at any time for any reason, with or
without cause, with or without notice, by you or the Muscogee Staffing Solution. No representative
of Muscogee Staffing Solution has authority to enter into any agreement contrary to the foregoing
"employment at will" relationship. You understand that your employment is "at will," and that you
acknowledge that no oral or written statements or representations regarding your employment can
alter your at-will employment status, except for a written statement signed by you and either our
Executive Vice-President/Chief Operations Officer or the Company's President.
Applicant _____________________ Dated:____________________
Signature: _________________________
