Employment Application

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We consider applicants for all positions without regard to race, color, religion, creed, gender, age, disability, martial or veteran status, sexual orientation, or any other legally protected status.

Personal Information

Position(s) applied for
Application Date:*
Available to Work:
How did you Learn about us:
Full Name:*
Address:*
Phone:
-
Phone Type:
Date of Birth:
E-mail:
If you are under 18 years of age, can you provide proof of your eligibility to work:*
Have you ever filed and application with us before:
Have you ever been employed with us before?
Are you currently employed:
May we contact your current employer:
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status:

Proof of citizenship or immigration status will be required upon employment

Are you available to work:
Are you currently on "lay-off" status and subject to recall:
Can you travel if the job requires:
Have you ever been convicted of a felony within the past 7 years

Conviction will not necessarily disqualify an applicant from employment.

If yes, please explain:
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Employment History

Start with your present (or last) job, include any job related military service assignments and volunteer activities.  You may exclude organizations, which include or indicate race, color, religion, gender, national origin, disabilities, or other protected status

Employer (E1):
Employer's Phone (E1):
-
Address (E1):
Position Held (E1)
Supervisor (E1)
Date employment began (month/year) (E1):
Ended (month/year) (E1):
Starting Hourly rate / salary (E1):
Ending Hourly rate / salary (E1):
Work Performed (E1):
Reason for leaving (E1):
Employer (E2):
Employer's Phone (E2):
-
Address (E2):
Position Held(E2):
Supervisor (E2):
Date employment began (month/year) (E2):
Ended (month/year) (E2):
Starting Hourly rate / salary (E2):
Ending Hourly rate / salary (E2):
Work Performed (E2):
Reason for leaving (E2):
Employer (E3):
Employer's Phone (E3):
-
Address (E3):
Position Held (E3):
Supervisor (E3):
Date employment began (month/year) (E3):
Ended (month/year) (E3):
Starting Hourly rate / salary (E3):
Ending Hourly rate / salary (E3):
Reason for leaving (E3):
Work Performed (E3):
Employer (E4):
Employer's Phone (E4):
-
Address (E4):
Position Held (E4):
Supervisor (E4):
Date employment began (month/year) (E4):
Ended (month/year) (E4):
Starting Hourly rate / salary (E4):
Ending Hourly rate / salary (E4):
Reason for leaving (E4):
Work Performed (E4):
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Other Qualifications

Summarize special job related skills and qualifications acquired from employment or other experience
Specialized Skills:
Production / Mobile Machinery (list):
Other (list):
Any additional information you feel may be helpful to us in considering your application

Note to applicants:  DO NOT ANSWER the following question unless you have been informed about the requirements for the job your are applying.

Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied:

Please list 3 Personal References

Name, address, telephone number (R1):*
Name, address, telephone number (R2):
Name, address, telephone number (R3):
List any professional, trade, business, or civic activities and offices held. You may exclude membership, which would reveal gender, race, religion, national origin, age, ancestry, disability, or any other protected status:
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Education, Training and Skills

Elementary school and address
Years completed
High School and address
Years completed, diploma:
Undergraduate school and address
Course of study, diploma or years completed
Graduate school and address
Diploma or years completed
Professional Certifications

Indicate any foreign language you can speak, read and/or write

Language 1
Speaking (Language 1)
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Reading/writing (Language 1)
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Language 2
Speaking (Language 2)
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Reading/writing (Language 2)
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Language 3
Speaking (Language 3)
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Reading/writing (Language 3)
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Describe any specialized training, apprenticeship, and extra-curricular activities
Describe any job-related training received in the United States military
I am not a robot:
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Our staff of 200 employees call central Oklahoma home. We raise our families here and we provide health care for people (here).

Oklahoma Central Intake:
T: 1.866.556.8464
F: 405.300.1275

Noble - Corporate Office
100 Woodbriar
Noble, OK 73068
T: 405.872.1515
F: 405.872.7478

Noble - Hospice
100 Woodbriar
Noble, OK 73068
T: 405.872.7393
F: 405.872.9694

Purcell – Home Health
301 W. Main
Purcell, OK 73080
T: 405.527.1117
F: 405.527.8899

Purcell – Hospice
316 W. Polk St.
Purcell, OK 73080
T: 405.527.3756
F: 405.527.3767

Shawnee Home Health
1940 N. Harrison St
Shawnee, OK 74804
T: 405.395.9300
F: 405.395.9494

Shawnee Hospice
1940 N. Harrison St
Shawnee, OK 74804
T: 405.395.9300
F: 405.395.9494

Stratford
300 W. Smith St, PO Box 572
Stratford, OK 74872
T: 580-759-3800
F: 580.759.3805

Yukon
1411 Healthcenter Parkway
Yukon, OK 73099
T: 405.805.5500
F: 405.805.5505

Lindsay
301 E. Cherokee St, Suite A
Lindsay, OK 73052
T: 405.756.1588
F: 405.756.1590

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