Personal

First Name: Last Name:
Address:
City/State: Email:
Zip Code:
Polo Shirt: Male Female Size: XS | S  | M  | L 
 XL | XXL |XXXL
Cell Phone Number: Date of Birth:
Marital Status: Single Married Spouse's Name:
If Children, Names and Ages:
Emergency Contact: Emergency Phone:
Any dietary restrictions?

Employment

Current Employer: Business Type:
Title Position: Employed Since:
Work Phone:
Address:
City: State:
Zip:    
Describe your responsibilities:
What do you consider to be your most rewarding career achievement?

Employment History - List past employment

From-To Employer Job Title/Position Describe Responsibilities

Education

From-To Educational Institution Degree/Major

Business & Professional Affiliations

From - To Organization Position

Community Involvement/Honors

From - To Organization Position

Hobbies/Interests (max. 100 words)

Why would you like to be a part of the TEAM South? (max. 100 words)

 

TEAM South is completely accessible to people with a disability in accordance with the Americans with Disabilities Act. If you have any special needs that we need to be aware of, please contact Patricia Paes at (405) 634-1436.

Employer Commitment Disclaimer

I acknowledge that being a part of TEAM South is a time commitment for my employee and I fully support his/her participation in the program.
Employer Signature:    
Applicant's Signature: Date:  
For more information, please visit www.southokc.com
Call 634-1436 or email pcsocc@coxinet.net