Full name

 I, being an employee or applicant for employment at JGVE, Inc. hereby acknowledge the following:

E-mail Address

Are you a convicted SEX OFFENDER in the State of Oklahoma or the United States of America that is subject to any Sex Offenders Registration Act? Yes  No

Social Security Number

Have you been convicted in the State of Oklahoma or the United States of America of ANY FELONY OFFENSE within the last 10 years? Yes  No

Business Phone

If you have been convicted of a felony offense in the last 10 years, have you received a Presidential or Gubernatorial Pardon? Yes  No

Home Phone

NOTE: UPON SUBMISSION OF THIS FORM, you will automatically be taken to the Employment History Form.

You understand and acknowledge the fact that pursuant to 57 O.S. 589, it is unlawful for any person registered pursuant to the Sex Offenders Registration Act or a convicted felon to work with or provide services to children or to WORK ON SCHOOL PREMISES. This information I have provided is truthful and accurate and I certify to this under the penalty of law.

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