Fillable APPLICATION FOR ELECTED POSITIONS (Oneida Tribe of Indians of Wisconsin)

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APPLICATION FOR ELECTED POSITIONS (Oneida Tribe of Indians of Wisconsin)

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BROWSE ONEIDA TRIBE OF INDIANS OF WISCONSIN (WI) FORMS

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APPLICATION FOR ELECTED POSITIONS
Oneida Business Committee, Judges, Legal Resource Attorney and Advocate, Boards, Committees, and Commissions
INFORMATION AND INSTRUCTIONS
CONFLICT OF INTEREST
Conflict of interest means any interest, real or apparent, whether it be personal, financial, political, or otherwise, in
which an elected official, officer, political appointee, employee, contractor, or appointed or elected member, or their
immediate family members, friends or associates, or any other person with whom they have contact, have that conflicts
with any right of the Nation to property, information, or any other right to own and operate activities free from
undisclosed competition or other violation of such rights of the Nation. In addition, conflict of interest also means any
financial or familial interest an elected official, officer, political appointee, employee, contractor, or appointed or elected
member or their immediate family members may have in any transaction between the Nation and an outside party.
Oneida Election Law §102.5-3. No applicant may have a conflict of interest with the position for which they are being
considered, provided that any conflict of interest which may be eliminated within thirty (30) calendar days of being
elected shall not be considered as a bar to nomination or election.
APPLICATION REQUIREMENTS
It is the applicant’s responsibility to ensure their application is complete
All fields are required unless noted otherwise
An application must be completed for each vacancy you are applying for
Provide proof of address (Valid WI drivers license, utility bill, insurance statement, rent receipt or mortgage
statement)
Judge Applicants – Submit a completed Disclosure and Authorization to comply with §801.11-1. (a)(4) of the
Judiciary law. The Disclosure and Authorization is in a separate packet.
Applications and petitions where the applicant was not nominated during caucus shall be filed by presenting the
information to the Nation’s Secretary, or designated agent, during normal business hours, 8:00 a.m. to 4:30 p.m.
Monday through Friday, within five (5) business days after the caucus. No mailed, internal Nation mail delivery,
faxed or other delivery method shall be accepted.
Board, Committee, and Commission applicants, please note: You must be available to provide quarterly reports in
accordance with the Boards, Committees and Commissions law §105.12-3 §At least one (1) member of the entity shall
attend the Oneida Business Committee meeting where the quarterly report is an agenda item.”
CONTACT US
Phone:
(920) 869-4364
Email:
BOARDS@ONEIDANATION.ORG
In Person:
NORBERT HILL CENTER, 2
ND
FL
N7210 SEMINARY RD
ONEIDA WI 54155
Mail:
BCSO
PO BOX 365
ONEIDA WI 54155-0365
Website:
https://oneida-nsn.gov/government/boards-committees-and-commissions/
APPROVED BY OBC 2020 02 26
Secretary Stamp Only:
Oneida Nation
Oneida Election Board
PO Box 365, Oneida WI 54155-0365
Ph: (920) 869-4364 Fax: (920) 869-4040
Email: Election_Board@oneidanation.org
SECTION 1: NAME OF ENTITY YOU ARE APPLYING FOR
SECTION 2: APPLICANT INFORMATION
Roll #:
Date of Birth:
(IF APPLICABLE)
FIRST
MIDDLE
LAST
MAIDEN (IF ANY)
STREET
APT
CITY
STATE
ZIP
:
(if different from above)
STREET/PO BOX
APT
CITY
STATE
ZIP
County of Residence:
Phone:
Email:
OFFICE USE ONLY
Valid WI Driver License/State ID
Current Utility Bill
Current Insurance Statement
Current Rent Receipt/Mortgage Statement
Note: Oneida Nation Enrollment Identification cards are not accepted.
APPROVED BY OBC 2020 02 26
SECTION 3: HISTORY – COMPLETE APPLICABLE SECTIONS. Attach resume or additional sheet(s) as needed
History on Boards, Committees and Commissions
ELECTION BOARD
*
ONEIDA COMMISISON ON AGING
*
GAMING COMMISSION
Board, Committee or Commission (most recent first)
Years
Position
Employment History
GAMING COMMISSION * LAND COMMISSION * CHIEF JUDGES * GTC ATTORNEY * LEGAL RESOURCE ADVOCATE
Employer (most recent first)
Years
Position
Education
GAMING COMMISSION * ALL JUDGES * GTC ATTORNEY * LEGAL RESOURCE ADVOCATE
Name and Address of Institution (most recent first) Years
Credits
Completed
Degree
ALL JUDGES
Must provide Disclosure and Authorization
A completed Disclosure and Authorization to comply with Subsection 801.11-1.(a)(4) of the Judiciary law is attached.
SECTION 4: APPLICANT SIGNATURE, ACKNOWLEDGMENT AND RELEASE
I acknowledge that all information provided in and with this application is true and correct.
If elected for the position applied for in this application, I will not disclose any information, confidential or
otherwise, to any outside source, unless first approved by the appropriate parties. Further, I understand I may be
subject to the Removal Law for failure to abide by this statement.
I declare the disclosure of any conflicts of interest and any future conflict(s) will be provided to the appropriat
e
party. Further, I understand I may be subject to the Removal Law for failure to disclose any and all conflicts,
whether future or overlooked, in writing to the appropriate parties.
I understand that if elected I am responsible to uphold the laws and regulations of the Oneida Nation includin
g
b
ut not limited to the Code of Ethics law.
I hereby authorize all persons and/or entities to which this release is presented, having information related to or
concerning the applicant, to furnish any and all such information to the Oneida Election Board.
Signature:
Date:
PRINT NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
APPROVED BY OBC 2020 02 26
Secretary Stamp Only:
Oneida Nation
Oneida Election Board
PO Box 365, Oneida WI 54155-0365
Ph: (920) 869-4364 Fax: (920) 869-4040
Email: Election_Board@oneidanation.org
Background Investigation
In addition, to the BCC application, this form is REQUIRED for Applicants applying for:
GAMING COMMISSION * TRUST ENROLLMENT COMMITTEE * ALL JUDGES
SECTION 5: BACKGROUND INFORMATION
Date of Birth:
Social Security #:
Driver’s License #:
State Held:
Name:
FIRST
MIDDLE
LAST
MAIDEN (IF ANY)
SECTION 6: OTHER NAMES (List any previously used or alias names, attach additional pages, if needed)
1.
3.
2.
4.
SECTION 7: PREVIOUS ADDRESSES List address for the past 10 years (most recent first) attach additional pages, if needed.
1.
3.
STREET
APT
STREET
APT
CITY
STATE
ZIP
CITY
STATE
ZIP
From:
To:
From:
To:
MM/YYYY
MM/YYYY
MM/YYYY
MM/YYYY
2.
4.
STREET
APT
STREET
APT
CITY
STATE
ZIP
CITY
STATE
ZIP
From:
To:
From:
To:
MM/YYYY
MM/YYYY
MM/YYYY
MM/YYYY
SECTION 8: APPLICANT SIGNATURE AND RELEASE FOR BACKGROUND INVESTIGATION
I acknowledge that all information provided in and with this application is true and correct.
I hereby authorize all persons and/or entities to which this release is presented, having information related to or
concerning the applicant, to furnish any and all such information to the Oneida Business Committee Support
Office for purposes of appointment to an Oneida Nation Corporate Board.
In addition, my signature below authorizes the Business Committee Support Officer or their Designee/Incheck to
complete a background check related to this application.
Signature:
Date:
Certificate of Notary Public
(SEAL)
Subscribed and sworn to before me this
day
of
,
Notary Signature:
My commission expires:
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APPLICATION FOR ELECTED POSITIONS (Oneida Tribe of Indians of Wisconsin)

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Completed 20 July 2020

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