Kansas.gov | Governor Jeff Colyer, M.D. | Department of Administration

State of Kansas Employment Application

ACCOMMODATIONS: The Americans with Disabilities Act of 1990 ensures you the right to reasonable accommodations. A request for an accommodation will not affect your opportunities for employment with the State of Kansas. Arrangements will be made if you have a disability that requires an accommodation for completing an application form, interviewing or any other part of the employment process. It is your responsibility to make your needs known to the Division of Personnel Services at 785-296-4278 or the agency to which you are applying. THE STATE OF KANSAS IS AN EQUAL OPPORTUNITY EMPLOYER

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification documentation upon hire.

Saving Your Application: To save your application, you will need to hit the submit button at the bottom of the page without filling in the Vacancy Requisition Number and State Agency fields that are listed below. We suggest saving your application often so as not to lose all your data. After you have pressed the submit button, you will be asked to save your file as a text (.txt) file and a Word (.docx) file. The .txt file is for future uploading and updating of your application and the Word file is for printing.

File Upload: If you have previously saved your application as a text (.txt) file on your computer, you can upload that file to populate this application and make updates. Upload File

All fields marked with an * are required and must be completed.

Position for which you are applying

Vacancy Requisition Number:

Job Title:

Agency:

Submit this application form to the agency which has the vacancy for which you are applying.
DO NOT SUBMIT THIS FORM TO ANY OTHER AGENCY. If an agency is not listed in this drop-down list, please refer back to the job description for details on how to apply.

Personal information

You will have an applicant identification number only if you have already completed a State of Kansas Employment Registration Form. Otherwise use your Social Security Number. If you are or have been a state employee, the applicant identification number is your employee identification number.

Applicant Identification Number: (Please insert "Pending" if you are waiting for your Applicant ID number)

Social Security #: (Ex. 999887777)

* Last Name:

* First Name:

Middle Initial:

* Street Address:

* City:

* State:

* Zip Code:

Phone Number:

Message Number:

* Email:

Are you known to employers/references/schools by another name? If yes, name:

Have you worked for the State of Kansas before or do you now? If yes, dates:

* Have you previously retired from the State of Kansas or any other KPERS employer?: YesNo

* Have you ever been convicted of a felony?: YesNo

* How did you hear about this job?:

Veteran's Preference

* Are you claiming Veteran's Preference?: YesNo

Educational Background

Reason for Leaving:

Title:

Duties:

List Computer Skills used in this Position:

Largest Number of People Supervised:

Supervisor's Name:

Supervisor's Phone Number:

Other Related Experiences

Professional certifications, honors, special skills, qualifications, or experiences not mentioned elsewhere, i.e., equipment or machines operated, etc.:

Computer Skills (name software and hardware):

Supplemental Work Experience (Please include the dates and hours worked):

References

Reference 1

Name:

Is this person your supervisor?:
YesNo

Occupation:

Organization:

Phone (Day):

Mailing Address:

Reference 2

Name:

Is this person your supervisor?:
YesNo

Occupation:

Organization:

Phone (Day):

Mailing Address:

Reference 3

Name:

Is this person your supervisor?:
YesNo

Occupation:

Organization:

Phone (Day):

Mailing Address:

Affirmation

I affirm that the facts set forth above in my application for employment are true, correct and complete to the best of my knowledge.

I understand that I may be required to submit information not requested on this application form; that the employing agency may verify any information provided by me in the employment process; and that incomplete information or omission of my signature is just cause for rejection of my application.

The employing agency may verify your level of expertise through reference checks. Should you be selected for an employment interview, be prepared to discuss the selections you have identified on this registration form.

I understand and agree that, if hired, my employment would be contingent upon conditions specific to the position for which I am applying. I also understand that any omission of information, or erroneous information provided in any part of the employment process, would be sufficient cause for discharge. I agree that the employing agency may, at its sole discretion, provide compensatory time off in lieu of overtime pay if I were employed in a nonexempt position and if there were no existing agreement to the contrary.

If you are applying for a vacancy which has a requisition number (Req. No.), you must also complete a State of Kansas Employment Personal Data Form, if you have not already done so. The Personal data Form can be completed online through the website, or paper employment registration forms are available from any state agency, state university, Workforce Centers, and the Civil Service Employment Information office. For general information about the State of Kansas employment process, phone Civil Service Employment Information (Department of Administration, Topeka, Kansas) at 785-296-4278.

THE STATE OF KANSAS IS AN EQUAL OPPORTUNITY EMPLOYER

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