Fillable Application For Employment FIllable PDF Updated 4 1 2019 (Little Priest Tribal College)

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Application For Employment FIllable PDF Updated 4 1 2019 (Little Priest Tribal College)

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The Application For Employment FIllable PDF Updated 4 1 2019 (Little Priest Tribal College) form is 3 pages long and contains:

  • 1 signature
  • 31 check-boxes
  • 109 other fields

Country of origin: US
File type: PDF

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Personal Information
Last Name
First Name
Middle Name
Are you authorized for employment in
the U.S.? ☐ Yes ☐ No
Address
City State Zip
How long have you lived here?
Years. Months.
Previous Address
City State Zip
How long have you lived there?
Years. Months.
Contact phone
( ) - __________ - ______________
If you are under 18, please provide your
age:
Education
High School
Address City ST Zip
Graduated/GED?
☐ Yes ☐ No
Degree Received?
College
Name Address City, ST Zip
Area of Study
Graduated?
☐ Yes ☐ No
Degree Received?
College
Name Address City, ST Zip
Area of Study
Graduated?
☐ Yes ☐ No
Degree Received?
College
Name Address City, ST Zip
Area of Study
Graduated?
☐ Yes ☐ No
Degree Received?
College
Name Address City, ST Zip
Area of Study
Graduated?
☐ Yes ☐ No
Degree Received?
Position Desired: _________________________________
Are you able to perform the essential duties of the above
position with or without accommodations? ☐ YES ☐ NO
Salary Expected: $______________ per _______________
Date Available to Start: ____________________________
AVAILABILITY (check all that apply):
☐ Temp ☐ PT ☐ FT ☐ Seasonal ☐ Mon
☐ Tues ☐ Wed ☐ Thu ☐ Fri ☐ Sat ☐ Sun
☐ Evenings ☐ Overtime
At LPTC, we are committed to hiring a workforce that is as diverse and inclusive as the people and communities we serve. Employment
practices are free of discrimination. Indian preference applies. All other applicants have equal opportunities of employment irrespective of
their race, creed, color, religion, national origin, sex, age, marital status, gender identity, physical or mental disability, or veteran status.
LPTC will uphold these principles and ensure that this philosophy is administered appropriately. Arrangements for reasonable
accommodations required by disabilities can be made by contacting the Human Resources office at 601 E. College Drive Winnebago, NE
68071 p.402-878-2380.
APPLICATION
for
EMPLOYMENT
The Office of Human
Resources
PLEASE TYPE or PRINT CLEARLY using black or blue ink.
Fill out application completely. Do not indicate “See Resume”
Incomplete or illegible applications may not be considered.
Don’t forget to sign and date your application.
Contact us to request an accommodation, if needed.
Allow two weeks for application processing
Employment History
List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities.
If you have less than 5 years of employment, include personal references to be contacted. May we contact your current employer? ☐Yes ☐ No
Dates MM/YY
Name and Address of Employer
Position/Major Duties
Reason for leaving
START:
END:
Supervisor:
Industry:
Ending Salary:
Phone:
Dates MM/YY
Name and Address of Employer
Position/Major Duties
Reason for leaving
START:
END:
Supervisor:
Industry:
Ending Salary:
Phone:
Dates MM/YY
Name and Address of Employer
Position/Major Duties
Reason for leaving
START:
END:
Supervisor:
Industry:
Ending Salary:
Phone:
Dates MM/YY
Name and Address of Employer
Position/Major Duties
Reason for leaving
START:
END:
Supervisor:
Industry:
Ending Salary:
Phone:
MISCELLANEOUS
Have you previously applied at LPTC?
☐ Yes ☐ No If yes, please indicate when __________
Have you previously been employed by LPTC? ☐ Yes ☐ No
If yes, please indicate dates: From________/__________ to ________/__________
Referral Source; how did you hear about us
(please be specific)?
Do you have a valid driver’s license? ☐ YES ☐ NO If position requires driving, please list violation(s) in the last
three years:
Do you have any friends or family employed at LPTC? (name and relationship please):
If hired, do you have transportation to
and from work? ☐ YES ☐ NO
Have you ever been convicted of, or pled guilty to, a crime for which the record has not been expunged or sealed? ☐ Yes ☐ No
If yes, please explain. Answering yes to this question will not necessarily bar you from employment.
Special Skills (as they relate the position applied for)
Other Skills applicable to position applied for:
PROFESSIONAL REFERENCES – List three person who have knowledge of your work performance in the past three years.
Full Name
Address
Phone
Occupation
Please Read This Statement Carefully
I certify that all information I have provide in order to apply for and secure work with this employer is true, complete and correct.
I expressly authorize, without reservation, the employer, and its representatives, employees or agents to contact and obtain information from all
references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the
accuracy of all information provided by me in this application, resume, or interview. I hereby waive any and all rights and claims I may have
regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a
lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I
understand that this employer does not unlawful discriminate in employment and no question on this application is used for the purpose of limiting
or eliminating any applicant form consideration for employment on any basis prohibited by applicable local, state, and federal law. I understand
that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be
considered for employment, it will be necessary for me to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves
the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law.
This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no
supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements
contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that
federal immigration laws require me to complete an I-9 Form in this regard.
I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to
(1) eliminate me from further consideration for employment, or (2) may result in my immediate discharge from the employer’s service, whenever it
is discovered.
DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.
Signature of Applicant___________________________________________________ Date______/_______/__________
Printed Name___________________________________________________
601 East College Drive, Winnebago, NE 68071 p.402-878-2380 f.402-878-2319 Visit us on the web at: www.littlepriest.edu
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Application For Employment FIllable PDF Updated 4 1 2019 (Little Priest Tribal College)

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Completed 19 September 2020

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