Employment Application

Applicant Information

Last Name *

First *

M.I.

Date

Street / Mailing Address

Apartment / Unit #

City

State

ZIP

Phone *

E-mail Address *

Date Available

Social Security No.

Desired Salary

Position Applied for *

Are you a citizen of the United States? Yes No

If you worked here before, when?

If not a citizen, are you authorized to work in the U.S.? Yes No

Have you ever worked for the Tribe before? Yes No

Have you ever been convicted of a felony? Yes No

If yes, please explain

Education

High School

Address

From

Did you graduate? Yes No

Degree

College

Address

From

Did you graduate? Yes No

Degree

Other

Address

From

Did you graduate? Yes No

Degree

References

Please list three professional references.

Full Name

Relationship

Company

Phone

Full Name

Relationship

Company

Phone

Full Name

Relationship

Company

Phone

Previous Employment

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities (max 180 characters)

From

Reason for Leaving

May we contact this supervisor for a reference? Yes No

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities (max 180 characters)

From

Reason for Leaving

May we contact this supervisor for a reference? Yes No

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities (max 180 characters)

From

Reason for Leaving

May we contact this supervisor for a reference? Yes No

Tribal Membership

Tribal Affiliation

Tribal Enrollment #

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature (type your full name) *

Date

Employment Application

Online Application Form

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