Fillable Application for Employment (Chitimacha Tribe of Louisiana)

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Application for Employment (Chitimacha Tribe of Louisiana)

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Application for Employment
Chitimacha Tribe of LA
P.O. Box 661
Charenton, LA 70523
Please Print
Name Social Security #
Last First Middle
Number & Street Name City State Zip Code
Mailing Address:
Number & Street Name City State Zip Code
Telephone # Mobile/Beeper/Other Phone # Email
Position(s) applied for Date of application
Referral Source (Please check the appropriate category and name the source)
Walk-in Will you travel if job requires it? Yes No
Employee If they have been explained to you,
Advertisement
Company’s Website
Other
Will you work overtime if required? Yes No
If NO, please explain
If necessary, best time to call you at home is
AM
PM
May we contact you at work? Yes No
If YES, work number and best time to call:
AM
PM
State
Yes No Have you ever been bonded? Yes No
If NO, please explain
Have you ever been employed here before? Yes No
If YES, give date(s) From To
Are you legally eligible for employment
in this country? Yes No
Date(s) available for work If YES, please provide date(s) and details
Physical Address:
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the
application and/or interview process should notify a representative of the Human Resources Department
Driver's License number required if driving may be required in the
job for which you are applying.
If YES, with regard to each offense, please provide the type of offense, the date and location of the
arrest or charge, and its disposition (e.g. dismissal, not guilty, also provide the sentence imposed and
the status of any probation, parole, or supervisory term).
Have you ever pled "Guilty" or "No Contest" to, or been convicted of a
felony? Yes No
If you are under 18 and it is required, can
you furnish a work permit?
Have you ever been arrested for or charged with a criminal offense (other
than minor traffic violations)? Yes No
are you able to meet the attendance
requirements of the position?
N/A Yes No
Answering "yes" to the following questions does not constitute an automatic bar to employment.
Factors such as date of the offense, seriousness, and nature of the violation, rehabilitation and
position applied for will be taken into account.
If you need more space to write down your explanation(s), you can do so on the last page of this application form.
What is your desired salary range or hourly rate of pay? Full-Time Part-Time
$ Per Substitute Temporary
Address
Number of Years Known
Employment History
Starting with your most recent employer, provide the following information.
Employer Telephone No. Dates Employed: Month Year
to
Month Year
Street address City State/Zip
Starting Job Title/Final Job Title
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Why did you leave?
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities.
Employer Telephone No. Dates Employed: Month Year
to
Month Year
Street address City State/Zip
Starting Job Title/Final Job Title
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Why did you leave?
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities.
Employer Telephone No. Dates Employed: Month Year
to
Month Year
Street address City State/Zip
Starting Job Title/Final Job Title
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Why did you leave?
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Give at least Three Personal References including Name, Address, and Telephone Number. Please exclude family members.
Compensation (Starting)
Name
Immediate Supervisor (for most recent Position held)
May we contact for Reference?
Yes No Later
Type of employment desired:
Immediate Supervisor (for most recent Position held)
May we contact for Reference?
Yes No Later
Telephone
May we contact for Reference?
Yes No Later
Immediate Supervisor (for most recent Position held)
Compensation (Final)
Compensation (Starting)
Compensation (Final)
Compensation (Starting)
Compensation (Final)
If you need more space to write down your explanation(s), you can do so on the last page of this application form.
Employment History (continued)
Summarize the type of work performed and job responsibilities.
Employer Telephone No. Dates Employed: Month Year
to
Month Year
Street address City State/Zip
Starting Job Title/Final Job Title
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Why did you leave?
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities.
Employer Telephone No. Dates Employed: Month Year
to
Month Year
Street address City State/Zip
Starting Job Title/Final Job Title
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Why did you leave?
Hourly Salary $ Per
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities.
Explain any gaps in your employment, other than those due to personal illness, injury, or disability
If not addressed on previous page, have you ever been fired or asked to resign from a job?
If YES, please explain
Skills and Qualifications
Summarize any special training, skills, licenses, and/or certificates that may assist you in performing the position for which you are
applying.
Compensation (Starting)
Immediate Supervisor (for most recent Position held)
May we contact for Reference?
Yes No Later
Compensation (Final)
Compensation (Starting)
Yes No
Immediate Supervisor (for most recent Position held)
May we contact for Reference?
Yes No Later
Compensation (Final)
If you need more space to write down your explanation(s), you can do so on the last page of this application form.
Computer Skills (check appropriate boxes, include software titles and years of experience.)
Word Processing Years: Internet Years:
Spreadsheet Years: Other Years:
Presentation Years: Other Years:
E-mail Years: Other Years:
Educational Background
Starting with your most recent school attended, provide the following information.
Years
Completed
GPA
Class
Rank
Major/Minor
List special accomplishments, publications, awards, etc.
Is there any other job-related information you want us to know about you?
Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other
similarly protected status.
Diploma_______________
Degree________________
Certification___________
Other_________________
GED__________________
Completed
School (include City and State)
Diploma_______________
Degree________________
Certification___________
Other_________________
GED__________________
Diploma_______________
Degree________________
Certification___________
Other_________________
GED__________________
Diploma_______________
Degree________________
Certification___________
Other_________________
GED__________________
If you need more space to write down your explanation(s), you can do so on the last page of this application form.
Applicant Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
DO NOT SIGN UNTIL YOU HAVE READ 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
I expressly authorize, without reservation, the employer, 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 provide by me in this
application, resume' or job 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 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 unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any
applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.
I understand that this application remains current for only 6 months. 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 to reapply and fill out a new application.
I also understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from
further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.
I understand that this document is an application for employment and continued employment is not being offered. I further understand that my employement can be terminated at will at any time
by myself or the Chitimacha Tribe of Louisiana for any or no cause. 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 Chitimacha Tribe of Louisiana 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 Chitimacha Tribe of Louisiana's Chief Administrative Officer.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me
to complete an I-9 Form in this regard.
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Application for Employment (Chitimacha Tribe of Louisiana)

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Completed 27 January 2021

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