Application

Job Application

First Name *

Last Name *

Date of Birth

Present Address

Phone Number

Driver's License Number

State Issued

SSN

Tribally Affiliated? Choose an option…YesNo

If yes, where?

Position Desired

Date you can start

Salary Desired

Are you currently employed? Choose an option…YesNo

If yes, may we contact your present employer? Choose an option…YesNo

Have you ever worked for this company before? Choose an option…YesNo

If yes, where?

High School Education- Name and Location of School, No. of years attended, Completion Date

College- Name and Location of School, No. of years attended, Completion Date, Subject Studied

Trade, Business, or Correspondence School?

Special Skills

Computer Experience

Activities (Civic, Athletic, etc.)

U.S. Military Service? Choose an option…YesNo

If yes, list rank

Present Membership in National Guard or Reserves? Choose an option…YesNo

List your last four employers, starting with most recent first (Dates from-to, employer name address and phone number, salary, position, reason for leaving)

List three persons not related to you, whom you have known for at least one year (name, address, years acquainted, phone number)

Emergency Contact

Emergency Contact Phone Number

Emergency Contact Relationship

Signature *

I CERTIFY THAT THE FACTS CONTAIN IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING THE SAME TO YOU. I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME, WITHOUT PRIOR NOTICE AND WITHOUT CAUSE.

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