Fillable BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF (Bad River Band Of Lake Superior Tribe Of Chippewa Indians)

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BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF (Bad River Band Of Lake Superior Tribe Of Chippewa Indians)

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U.S.A. forms for Bad River Band Of Lake Superior Tribe Of Chippewa Indians

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BAD RIVER BAND OF LAKE SUPERIOR
TRIBE OF CHIPPEWA INDIANS
Application for Employment
1 | P a g e
Revised: 10/18/2019
➢ Answer all questions completely. Any application received incomplete or after the closing date may not be considered for
employment.
➢ Review the MINIUM QUALIFIATIONS for the position you are applying for. If you do not meet the minimum qualifications, you
will not be considered for the position.
➢ Applications are kept on file for a period of 120 days. After 120 days you must submit a new application.
➢ Drug-Free Workplace in accordance with the Drug Free Workplace Act of 1988, P.L. 100-690 and the Bad River Tribe’s Employee
Policy & Procedure Handbook. Indian Preference will be given in accordance with P.L. 93-638 and the Tribe’s preference Policy.
➢ Federal law requires that all applications be considered without regard to race, religion, color, sex, age or national origin. The Bad
River Band of Lake Superior Tribe of Chippewa Indians is an equal opportunity employer, subject to the provisions of
P.L. 93-638/Indian Preference Act.
☐ Transfer/Promotion: Please check here to be considered as a transfer/promotion applicant.
NOTE: If an email address is provided, we will use this address for communication purposes.
(Applicant will be requested to provide documentation of enrollment status to comply with P.L. 93-638/Indian Preference act.)
☐ Yes
☐ No
Are you 18 Years or Older?
☐ Yes
☐ No
Have you ever been employed here before? If yes, what position?
☐ Yes
☐ No
Are you employed now? If yes, may we contact your current employer?
☐Yes
☐ No
☐ Yes
☐ No
Are you on layoff and subject to recall?
☐ Yes
☐ No
Are you willing to attend job related training?
☐ Yes
☐ No
Can you travel as the job may require at times?
☐ Yes
☐ No
Have you ever been convicted of a felony? If yes, please explain:
☐ Yes
☐ No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration
status?
☐ Yes
☐ No
NOTE TO THE APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS
OF THE JOB FOR WHICH YOU ARE APPLYING
Are you capable of preforming in a reasonable manner, with or without a reasonable accommodation, the activities
involved in the job or occupation for which you have applied?
Special Skills and Qualifications: Summarize Special Skills and qualifications acquired from employment or other experiences:
Position Applying For:
1.)
2.)
3.)
Date:
Last Name:
First Name:
Full Middle Name:
(Suffix ex. Jr, III)
Mailing Address:
City:
State:
Zip Code:
Tribal Affiliation:
Enrollment Number:
Email Address:
Home Phone Number:
Cell Phone Number:
MAILING ADDRESS:
P.O. BOX 39
ODANAH, WI 54861
FAX:
(715) 685-7118
Phone
(715) 682-7111
LOCATION:
CHIEF BLACKBIRD CENTER
72628 MAPLE ST.
P.O. BOX 39
ODANAH, WI 54861
WEBSITE:
http://www.badriver-nsn.gov/
Application for Employment
2 | P a g e
Revised: 10/18/2019
References (Preferred professional):
1.
2.
3.
Education
Information:
Name and Address of
School
Course of Study
Years
Completed
Confer Date
High School
General
College or
Technical
Education
College or
Technical
Education
Additional information you feel may be helpful:
Employment History: (Stating with your most current position)
1.)Employer:
Job Title:
Address:
Phone Number: ( )
Supervisor:
Month/Year Employed: From: To:
Reason for Separation:
Summarize job duties/responsibilities:
2.)Employer:
Job Title:
Address:
Phone Number: ( )
Supervisor:
Month/Year Employed: From: To:
Reason for Separation:
Summarize job duties/responsibilities:
3.)Employer:
Job Title:
Address:
Phone Number: ( )
Supervisor:
Month/Year Employed: From: To:
Reason for Separation:
Summarize job duties/responsibilities:
(Name) (Phone)
(Name) (Phone)
(Name) (Phone)
(Address) (Email)
(Address) (Email)
(Address) (Email)
Credits Completed
Credits Completed
Application for Employment
3 | P a g e
Revised: 10/18/2019
Check the following boxes if you are attaching additional documents. As requested per job description.
☐ Resume ☐ Cover Letter ☐ Transcript(s) ☐ Letter(s) of Reference
☐ Copy of Diploma ☐ Copy of License ☐ Copy of Certification(s) ☐ Documentation of Enrollment Status
If hired, can you provide valid documentation establishing your identity and eligibility to
be legally employed in the United states? ☐Yes ☐No
Note: A Social Security Card is not required to establish work eligibility, however, it
must be presented upon hire for payroll purposes.
(Proof of citizenship
or immigration
status is requested
upon employment.)
Social Security Number:
Date of Birth:
Driver’s License Number: State:
ACKNOWLEDGEMENT
I certify that answers given herein are true and complete to the best of my knowledge. I authorize
investigation of all statements contained in this application for employment as may be necessary in
arriving at an employment decision.
I understand that this application is not intended to be a contract of employment.
In the event of employment, I understand that false or misleading information is given on my
application of interview may result in discharge without recourse. I also understand that I am to
abide
by the Personnel Policies and Procedures of the Bad River Band of Lake Superior Chippewa
Indians.
Signature:
Date:
PRE-EMPLOYMENT DRUG/ALCOHOL TESTING
CONSENT AND RELEASE FORM
I hereby consent to submit to a drug or alcohol test and to furnish a sample of my urine, breath, and/or
blood for analysis, as shall be determined by Bad River Tribe in order to meet with their policy regarding
the selection of applicants for employment.
➢ I further authorize and give full permission to have the Bad River Tribe and/or its authorized
agents and physicians to send the specimen or specimens so collected to a laboratory for a screening
test for the presence of any prohibited substances under the policy, and for the laboratory or other testing
facility to release any and all documentation relating to such test to the Bad River Tribe. I further agree to
and hereby authorize the release of the results of said tests to the Bad River Tribe.
➢ I understand that it is the current use of illegal drugs that would prohibit me from being employed by the
Bad River Tribe.
➢ I further agree to hold harmless the Bad River Tribe and its agents and physicians from any liability arising
in whole or part, out of the collection of specimens, testing, and use of the information from said testing
in connection with the Bad River Tribe's consideration of my application of employment.
➢ I further agree that a reproduced copy of this pre-employment consent and release form shall have the
same force and effect as the original.
➢ I have carefully read the foregoing and fully understand its contents. I acknowledge that by signing of this
consent and release form is a voluntary act on my part and that I have not been coerced into signing this
document by anyone.
➢ The cost for the drug and alcohol testing will be $75.00 per drug screening. This fee can’t be waived, and
the money is non-refundable.
APPLICANT:
Print Name: S.S.#:
Signature: Date:
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Application for Employment
4 | P a g e
Revised: 10/18/2019
RELEASE OF INFORMATION
I, Herby authorize the
Bad River Tribe to conduct a “Background Security
Check,” to meet conditions of the employment with the
Bad River Tribe, and understand this information is valid
for the duration of my employment with the Bad River
Tribe.
Aliases:
Date of Birth: Social Security:
Driver’s License #:
(Please list all driver license numbers and states you have been issued a
license in within the past 5 years)
Signature:
Today’s Date:
All information gathered by the Employee Background Investigation Department will be
confidential.
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BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF (Bad River Band Of Lake Superior Tribe Of Chippewa Indians)

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Completed 12 November 2021

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