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Human Capital Management

Supplemental Questionnaire

Last Name First Name


OK Department of Human Services (DHS) requires that the following questions be answered before continuing with the application.


Do you have legal status to work in the United States?

Yes No

Have you had a protective order entered against you pursuant to the Oklahoma
Protection from Domestic Abuse Act or a similar statute of another state? 

If yes, provide the name of the court and court number in the text area:

If no, please enter No in the text area:            


DHS policy does not allow some family members to be employed within the same supervisory group or unit. Please list the names of all of your relatives now employed by DHS:

If no, please enter No in the text area:


Have you ever been terminated or resigned from employment in lieu of being terminated?  
If yes, explain circumstances:      

If no, please enter No in the text area: