100 - Technician
Jan 27, 2022
Personal Information
To move forward in the process, click on the arrow at the bottom of the page.
* = Required
** = Conditionally Required
Personal Information
Legal First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kaden
Preferred First Name .
..................................................... kaden
(Optional - Do not use values such as None or NA.)
Legal Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jackson
Legal Middle Name . James Perez
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Email Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . kjackson121213@gmail.com
Address 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 721 nw 16th street
Address 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Moore
Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States
State/Province** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oklahoma
Zip/Postal Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73160
Primary Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (405) 570-2025
Secondary Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
General Information
Are you at least 18 years of age? . Yes - I am at least 18 years of age
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Employment History
To add additional employers, click the "Add Employer" button below. The "Remove Last Employer" will delete all entries for the last employer that you have entered.
Please enter your most recent employer first.
* = Required
** = Conditionally Required
Employment History
Employer 1
Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Previous
Employer** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cross Timbers
Employer Phone** . (405) 251-9988
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City** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Midwest City
Country** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States
State** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oklahoma
Start Date** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05/01/2020
End Date** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10/15/2020
If Current, please leave blank
Start Position/Title . hospitality aid
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End Position/Title** . Senior Mental Health Center Maintenance
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May We Contact?** . Yes
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Job Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Small repairs Plumbing Construction Handyman work
Reason for Leaving or Looking to Leave** . they keeped putting me on a different job than that they had me marked as.
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To add additional information, click the Add button above. When you have completed entering your information, click on the forward arrow below to move to the next page of the application.
eSignature
ELECTRONIC SIGNATURE: Please type your full legal name as it is listed in the document above.
I certify that this statement is true to the best of my knowledge: Kaden James Perez Jackson
E-Signature
...................................................... kaden james perez jackson
Accepted
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Jan 27, 2022 09:53 pm
(System will autofill)
