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BURNS PAIUTE TRIBE 100 Pasigo St. Burns, OR (BURNS PAIUTE TRIBE)

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BURNS PAIUTE TRIBE
100 Pasigo St.
Burns, OR 97720
Phone (541)573-8013
Fax (541)573-5565
APPLICANT INFORMATION
Last Name
First
M.I.
Date
Street Address
Apartment/Unit #
City
State
Phone
E-mail Address
Date Available
Social Security No.
Desired Salary
Position Applied for
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for this company?
YES
NO
If so, when?
Have you ever been convicted of a felony?
YES
NO
If yes, explain
EDUCATION
High School
Address
From
To
Did you graduate?
YES
NO
Degree
College
Address
From
To
Did you graduate?
YES
NO
Degree
Other
Address
From
To
Did you graduate?
YES
NO
Degree
REFERENCES
Please list three professional references.
Full Name
Relationship
Company
Phone
( )
Address
Full Name
Relationship
Company
Phone
( )
Address
Full Name
Relationship
Company
Phone
( )
Address
PREVIOUS EMPLOYMENT
Company
Phone
( )
Address
Supervisor
Job Title
Starting Salary
$
Ending Salary
$
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
( )
Address
Supervisor
Job Title
Starting Salary
$
Ending Salary
$
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
( )
Address
Supervisor
Job Title
Starting Salary
$
Ending Salary
$
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature
Date
Print
Clear
click to sign
signature
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BURNS PAIUTE TRIBE 100 Pasigo St. Burns, OR (BURNS PAIUTE TRIBE)

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Completed 26 January 2021

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