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SCKRMC
216 West Birch
PO Box 1107
Arkansas City, KS,  67005
(620)442-2500

 

 
 

Position Appling For:

How did you learn about us?
Date of Availability:
Hours Available to work:

Personal Information:

 
Full Name:
Address:
City:
State:
Zip Code:
Area Code:
Home Phone: example: 634-8821
Cell Phone: example: 634-8821
Email Address:

Education:

 
Check highest grade completed: Name of School: Degree: Credits:
Major:
High School 9 10 11 12 GED
College   1 2 3  4
Graduate School 1 2  3
Business, Vocational or other

Are you currently attending school?

Yes

No

Special Skills:

Typing: Words/minute

Computer Skills: List software

Work Experience:

Start with most recent employer:

 
Employer: City/State: Date From: Date To: Position: Salary: Reason For Leaving:

Are you currently employed?
Yes
No

If yes, may we contact your present employer?
Yes
No

Whom should we contact?

Name:
Phone Number:

References:

 
Name: Company: Work Phone: Home/Cell Phone: Email: Job Title: Years Acquainted: