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Applicant Information

First Name Middle Name / Initial Last Name SSN

Current Address

Date of Birth Email Home Phone Cell Phone

General Information

Position Desired How did you learn about this job?

Employment type Full Time Part Time

Willing to work under extreme conditions? Able to perform essential functions with/without accommodation? Volunteer position - no compensation understood? Can you operate a motor vehicle?

Driver License # State Issued License Type Expiration Date

Driver License Upload

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Background Questions

Education

Law Enforcement / Correctional / Medical certifications Out-of-state certifications and numbers Other training Other languages

Military Experience

Member of U.S. Armed Forces? Branch Dates of Duty Rank Held

Duties Formal disciplinary action? Explanation

Employment Experience

Start with your present or most recent job.

May we contact your present employer? May we contact previous employers?

If not, explain why

Additional Information & References

Additional information/comments

Personal References

Professional References

PREA, Work Requirement & Social Media

Family/member or anyone known currently in custody? Details Previously incarcerated at OCDC? Dates/reason

Social Media

Disclosures & Authorizations

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1. Disclosure and Acknowledgment to Applicant for Employment

PLEASE READ BEFORE SIGNING

The Oklahoma County Criminal Justice Authority (鈥淥CCJA鈥? is committed to the full inclusion of all qualified individuals and provides all employees and job applicants with equal employment opportunities. OCCJA prohibits discrimination, harassment, or retaliation against employees and applicants based on race, color, religion, sex, sexual orientation, gender identity, gender expression, age, national origin, citizenship status, disability, genetic information, veterans鈥?status, or other legally protected classification. Applicants with a disability who feel they need an accommodation for the application and/or selection process should advise the Training Division in writing.

I have read the job requirements for the position I have applied for and certify that I am able to perform the essential job functions of the position with or without a reasonable accommodation.

I further certify that all statements and information contained herein are true and complete, and I understand that any misstatements, or omissions of material fact will result in a refusal of employment or termination of employment, if employed.

I understand OCCJA requires a thorough background investigation and may verify all data provided in this application. I hereby authorize my present and previous employers and educational institutions to provide the information requested to OCCJA.

I understand that as part of the selection process, applicants must participate in a physical agility test to determine their ability to meet the physical demands of the position, pass a written examination to measure the basic skills necessary to successfully perform the duties of the position, and attend a panel interview conducted by OCCJA personnel. If I am unable to complete any of these requirements successfully, with or without a reasonable accommodation, I understand that any further employment consideration will end, and I will be notified.

If I receive an offer of employment, I understand that the offer is contingent upon successfully completing a medical screening to determine that I can fulfill the physical requirements of the job and passing a comprehensive drug screening. I further understand that the offered position is classified as a safety-sensitive position, which means OCCJA may revoke the offer of employment, if I test positive for marijuana, even if I have a medical marijuana license.

I understand and acknowledge that this is only an application for employment. This application is not intended to and does not create a contract or an offer of employment. I understand that if I am hired, my employment will be at-will, meaning that OCCJA or I may terminate the employment relationship at any time with or without cause. It is further understood that if I am hired, the terms, conditions, and privileges of employment can be changed at any time by the Jail Administrator or authorized designee.

OCCJA鈥檚 operational needs may at times require employees to work mandatory overtime, work a specific shift, work a rotation schedule, work a schedule other than Monday through Friday, or reassignment to another job post. I understand and accept these conditions, if I am hired.

If I am hired, I agree to comply with all laws, rules, regulations, personnel policies, and jail operational policies and procedures.

I have read or have had this application read to me and understand all statements and questions contained in the application for employment and have answered to the best of my ability.

I accept this disclosure and acknowledgment.

2. Authorization to Release Information for Employment

I am an applicant for employment with the Oklahoma County Criminal Justice Authority (the 鈥淥CCJA鈥?. OCCJA needs to thoroughly investigate my background and personal history to evaluate my qualifications to hold the position for which I applied. It is in the public鈥檚 interest that all relevant information concerning my personal and employment history be disclosed to the above agency.

I hereby request and authorize you to release to the OCCJA, any and all information or records concerning me, my background and personal history, my employment, education, military service, or criminal history. The intent of this authorization is to give my consent for full and complete disclosure of any and all information or records, including photocopies, whether private, public, confidential, or privileged, and to include the contents of investigatory files, evaluations or ratings, complaints or grievances filed against me.

A photocopy or FAX copy of this release form will be valid as an original thereof, even though the said photocopy or FAX copy does not contain an original writing of my signature.

I agree to indemnify and hold harmless any person to whom this request is presented and his agents and employees from and against all claims, damages, losses and expenses, arising out of or by reason of complying with this request.

Failure to release the information requested by the OCCJA may result in the discontinuance of the background investigation and the processing of my application.

For and in consideration of the OCCJA鈥檚 acceptance and processing of my application for employment, I agree to hold the agency, its agents and employees, harmless from any and all claims and liability associated with my application for employment or in any way connected with the decision whether or not to employ me. I understand that should information of a serious criminal nature surface as a result to this investigation, such information may be turned over to the proper authorities.

This authorization is valid for one (1) year from the date of signature.

I authorize this release of information.

3. Background Release Authorization

I am an applicant for employment, contractor and/or volunteer services with the Oklahoma County Criminal Justice Authority (OCCJA). OCCJA needs to thoroughly investigate my background and personal history to evaluate my qualifications to hold the position for which I applied. It is in the public鈥檚 interest that all relevant information concerning my personal and employment history be disclosed to the above agency.

I hereby request and authorize you to release to the OCCJA, any and all information or records concerning me, my background and personal history, my employment, education, military service, or criminal history. The intent of this authorization is to give my consent for full and complete disclosure of any and all information or records, including photocopies, whether private, public, confidential or privileged and include contents of investigatory files, evaluation or ratings, complaints or grievances filed against me.

A photocopy or an email copy of this release form will be valid as an original thereof, even though the said photocopy or an email copy does not contain an original writing of my signature.

I agree to indemnify and hold-harmless any person to whom this request is presented and his agents and employees from and against all claims, damages, losses and expenses, arising out of or by reason of complying with this request.

Failure to release the information requested by the OCCJA may result in discontinuance of the background investigation and the processing of my application.

For and in consideration of the OCCJA鈥檚 acceptance and processing of my application for employment, contract or volunteer service, I agree to hold the agency, its agents and employees, harmless from any and all claims and liability associated with my application for employment, contract or volunteer service or in any way connected with the decision whether or not to employ, contract or allow volunteer service with me. I understand that should information of a serious criminal nature surface as a result of this investigation, such information may be turned over to the proper authorities.

This authorization is valid for one (1) year from the date of signature.

I authorize this background release.

Name of Contractor or Volunteer Service, if applicable

Printed Name Date Signed

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