The Hcm 4 B form serves as a comprehensive tool in the personnel hiring process, facilitating the documentation and validation of an applicant's personal data and professional qualifications. This essential document, formally known as the Personal Data Summary Sheet OP-110235, Attachment K, is a critical piece of the recruitment puzzle for the State of Oklahoma, especially for positions within the Department of Corrections. It meticulously collects vital information ranging from job family and level certification requests, personal identifiers, educational background, and employment history, to specific certifications or licenses the applicant may hold. Additionally, this form demands details of qualifying experience relevant to the job in question, starting with the most immediate past employment. Prospective employees are urged to provide contact details to ease the scheduling of interviews and are reminded of the legal implications of providing false information, as outlined by Title 21 O.S. Section 358. The form also incorporates an authorization section for the review of the applicant’s performance evaluations by the hiring agency. An extension of this documentation, the Department of Corrections Supplemental Personal Data Summary Sheet, is aligned with the requirements of the Prison Rape Elimination Act, asking pointed questions about past engagements in any form of sexual misconduct. This acts as a safeguard, ensuring the integrity and safety of the correctional facilities. The form reaffirms the State of Oklahoma’s commitment to transparency, accountability, and safety in its hiring practices, marking a significant step in the selection of qualified and reputable personnel.
| Question | Answer |
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| Form Name | Form Hcm 4 B |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | opm 4b form |
PERSONAL DATA SUMMARY SHEET |
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(The original copy must be submitted to the requesting agency’s personnel office. Retain a copy for your records.)
TITLE OF JOB FAMILY AND LEVEL FOR WHICH CERTIFICATION IS REQUESTED:
NAME: |
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SSN: |
Empl ID: |
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Last |
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Middle |
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INFORMATION ON THIS FORM IS SUBJECT TO VERIFICATION. |
Please provide a phone number where you can be reached between 8:00 a.m. and 5:00 p.m. to schedule your interview: |
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Education
Name
Location
Dates
Attended
Hours
Completed
Hours Completed or Degrees and Majors
Other |
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Registration, certification or licensure: Type: |
Granted By: |
Effective Dates:
QUALIFYING EXPERIENCE:
Employer and
Location
Position Held
Hours
Per Week
Date
Employed
Date
Separated
Description of Duties
Title 21 O.S. Section 358: “It shall be unlawful for any person applying for employment with the State of Oklahoma to make a materially false, fictitious or fraudulent statement or representation on an application, knowing such statement or representation to be materially false, fictitious or fraudulent. A violation of this subsection shall be punished as provided in subsection B of Section 359 of this title.”
I certify, subject to the penalties provided by law, that all information listed above is correct to the best of my knowledge.
DATE:
Signature of Employee or Personnel Officer
I authorize the hiring agency to review and photocopy any and all of my performance evaluations for their consideration in this hiring decision.
Signature of Employee
HCM
Human Capital Management Division |
IF YOU NEED ADDITIONAL SPACE, FILL OUT A BLANK SHEET IN THE SAME FORM AS THAT ABOVE. |
Office of Management and Enterprise Services |
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DEPARTMENT OF CORRECTIONS SUPPLEMENTAL PERSONAL DATA SUMMARY SHEET
NAME: |
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SSN |
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Last |
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The Prison Rape Elimination Act (§115.17) requires that the Department of Corrections ask the following questions prior to hiring or promoting staff (please check a response to each question):
Have you ever engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility, or other institution? |
Yes |
Have you ever been convicted (or civilly or administratively adjudicated) of engaging or attempting to engage in sexual activity in |
Yes |
the community facilitated by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to |
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consent or refuse? |
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Have you ever engaged in any incidents of sexual harassment? |
Yes |
If you answered yes to any question, please explain: _____________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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_______________________________________________________________________________________________________________ |
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P.R.E.A. §115.17(g): “Material omissions regarding such misconduct, or the provision of materially false information, shall be grounds for termination.”
I certify, subject to the penalties provided by law, that all information listed above is correct to the best of my knowledge.
DATE:
Signature of Employee
No
No
No
DOC
IF YOU NEED ADDITIONAL SPACE, FILL OUT A BLANK SHEET IN THE SAME FORM AS THAT ABOVE.