CASP

1023 N. FLOOD AVENUE

NORMAN, OK 73069

APPLICANT INFORMATION

First Name *

Middle Name

Last Name *

Local Street Address *

City *

Zip Code *

Permanent Mailing Address *

City *

State *

Zip Code *

Cell Number *

Alternate Phone

Date of Birth *

Social Security Number *

Email Address *

Emergency Contact (1) *

Emergency Contact (1) Phone *

Emergency Contact (2) *

Emergency Contact (2) Phone *

Do you have a high school diploma, General Education Development (GED) credential, or equivalent?

Yes

What is your major or degree area?

College/University/School

List experience, credentials &/or educational certificates related to working with youth (if applying for programming position).

0/400 characters

Are you receiving a Federal Work Study Award?

Yes

How did you hear about CASP?

SCHEDULE

Office Hours: Monday - Friday 8:00 am - 5:00 pm.; Programming Hours: Monday - Friday 3:00 pm - 6:00 pm. List Days and Hours you are available to work. *

If you are currently a student, please upload a copy of your class schedule.

PREVIOUS EMPLOYMENT

Employer Name (1)

City/State/Zip (1)

City (1)

Phone (1)

Dates of Employment (1)

Supervisor's Name (1)

Job Duties (1)

Employer Name (2)

City/State/Zip (2)

City (2)

Phone (2)

Dates of Employment (2)

Supervisor's Name (2)

Job Duties (2)

Employer Name (3)

City/State/Zip (3)

City (3)

Phone (3)

Dates of Employment (3)

Supervisor's Name (3)

Job Duties (3)

PERSONAL REFERENCES

Reference (1) First Name *

Reference (1) Last Name *

Reference (1) Relationship *

Reference (1) Mailing Address *

Reference (1) City *

Reference (1) State *

Reference (1) Zip *

Reference (1) Phone *

Reference (1) Email *

Reference (2) First Name *

Reference (2) Last Name *

Reference (2) Relationship *

Reference (2) Mailing Address *

Reference (2) City *

Reference (2) State *

Reference (2) Zip *

Reference (2) Phone *

Reference (2) Email *

Reference (3) First Name *

Reference (3) Last Name *

Reference (3) Relationship *

Reference (3) Mailing Address *

Reference (3) City *

Reference (3) State *

Reference (3) Zip *

Reference (3) Phone *

Reference (3) Email *

EXPERIENCE

Please share experience related to the position for which you're applying. *

BACKGROUND INVESTIGATION

Are you required to register under the Sex Offenders Registration Act or Mary Rippy Violent Crime Offenders Registration Act? *

Yes

Do you have pending charges, have you entered a plea of guilty or solo contender (no contest); or ben convicted of any criminal activity involving gross irresponsibility or disregard for the safety of others; violence against an individual; sexual misconduct; child abuse or neglect; animal cruelty; or possession, sale or distribution of illegal drugs? *

Yes

I understand by completing this form a background investigation will occur prior to hire. *

Yes

I understand my registration on the Child Care Registry (Restricted Registry) may occur when: a background investigation reveals a specified criminal history; or an action against a child in care results in a confirmed or substantiated finding of abuse or neglect. *

Yes

I certify the information provided on this form is true and complete. *

clear

Date * +

FINGERPRINTING INFORMATION

If hired, this section will be completed during employee orientation.

First Name

Middle Name

Last Name:

Local Street Address

City

Zip Code

County

List any aliases and/or maiden name.

Race

Height

Weight

Hair Color

Eye Color

Gender

In the last five years, have you lived outside the United States?

If yes, list location/states and dates of residence.

Have you been fingerprinted before for the purposes of childcare?

If yes, list where and when.