Application for Employment Page 3
APPLICANT STATEMENT OF UNDERSTANDING AND RELEASE OF LIABILITY
AS WELL AS REQUIREMENTS FOR A CRIMINAL BACKGROUND CHECK
AUTHORIZATION TO RELEASE INFORMATION
I, 84._______________________, am applying for a position with the Susanville Indian Rancheria. I hereby
signify my willingness to appear for interviews in regards to my application and authorize Susanville Indian
Rancheria's representatives to consult with other institutions with which I have been associated and personal
references who may have information bearing on my professional competence, character, ethical qualifications,
assaultive behaviors and criminal convictions. I further consent to the release/disclosure to the Susanville
Indian Rancheria all educational, professional and criminal records that may be material to an evaluation of my
qualifications and competence, as well as my ethical behavior for staff membership.
The Susanville Indian Rancheria will not hire or employ persons, nor allow persons to volunteer, for positions
that are subject to the Rancheria’s criminal background investigation policy (subsection 5 of Section 3 of the
SIR Personnel Policies & Procedures), who do not meet the minimum standards of character described in that
policy. The required background investigations are intended to determine suitability for employment.
Each individual age 18 or over who volunteers to assist or is employed in an area identified by the Susanville
Indian Rancheria as having regular contact with or control over children, will be subject to a criminal background
investigation, including fingerprinting. All persons subject to this requirement shall have their fingerprints
obtained by the Susanville Indian Rancheria Gaming Commission for processing through the FBI and State
Criminal history repositories for all States that are listed as current and former residences on the employment
application or volunteer form.
You have the right to obtain a summary of the criminal history report made available to the Susanville Indian
Rancheria Human Resources Department and to challenge the accuracy and completeness of any information
contained in the report.
Your signature below constitutes consent to the conduct of a criminal background investigation. Refusal will
prohibit your employment or ability to volunteer in any of the areas identified by the Susanville Indian Rancheria
as requiring a criminal background investigation.
I hereby release from liability all representatives, facilities, educational institutions and training programs that I
have attended and/or worked for, from their acts performed in good faith and without malice in connection with
evaluating my credentials and qualifications. I also hereby release from any liability any and all individuals and
organizations that provide information to the Susanville Indian Rancheria's staff in good faith and without malice
concerning my, education, professional competence, ethics, character and other qualifications.
I certify that the statements/documents that I have made/provided in this application are true, complete, and
correct to the best of my knowledge and belief, and are made in good faith.
I fully understand that a false statement to any question in this application or the misrepresentation of
information otherwise provided may cause my application to be disqualified or constitute immediate termination
I have read and understand above statement.
Social Security Number Driver’s License Number
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