Updated 3/2011
Date of application: __________________ Position for which you are applying: ______________________________________
Referral source: Word of mouth Shooting Star Employment posting Advertisement (_________________________)
Name: __________________________________________________________________________________________________
First Middle Last Maiden
Address:___________________________________________ City: ___________________ State: ________ Zip:_____________
Social Security Number: __________________________________
Phone number where you may be reached during work hours: (__________)______________ Ok to leave message? Yes No
Alternate contact number: (__________)____________________ Email address: _____________________________________
Check all types of work you would accept: Regular Full-Time Temporary Part-Time
When would you be able to start work? _______________________________________________________________________
Do you have a valid driver’s license? Yes No If yes, State ___________ DL Number ________________________________
Type of license: Operator Commercial Operator Chauffeur
Does your license have restrictions? Yes No If yes, please explain: __________________________________________
Do you have a high school diploma or equivalent? Yes No If yes, from where?________________________
What is the highest level of education you have completed? ______________________________________________________
(Elementary: 1 8; High School: 9 12; Some College; Associates; Bachelor’s; Master’s; PhD)
If you have attended college, university, vocational-technical or trades school, complete the following. Please note: If college
degree is required for the position for which you are applying you will be asked to provide an official transcript with seal, which
shows academic or vocational training beyond high school level.
Institution Name
and Location
Dates Attended
From (mo/yr) To
Area of Study
Total #
Degree / Certificate
Date Rec’d
Special Qualifications and Skills: List qualifications and skills you possess which are required for the job as stated in the job
posting or ad, such as typing proficiency (give speeds if known), computer program proficiencies or certifications, ability to
operate specialized machinery or equipment, or professional registration or licensing. Indicate any training or honors you have
had which are directly related to the job for which you are applying.
Experience: Please list all jobs held during the last 10 years, including part-time and/ or temporary positions. You may also
include military experience as employment. Start with your present or most recent job and work your way chronologically back.
Do not reference a resume. Use additional paper if necessary. You may include and receive credit for volunteer or other
unpaid work experience that is related to the job for which you are applying.
May we contact your present employer as to your qualifications and record of employment? Yes No
Application for Employment
Eastern Shawnee Tribe of Oklahoma
Human Resources Office
10080 S. Bluejacket Road
Wyandotte, OK 74370
918-666-5152, ext 1021
Fax: 888-971-3901
Email: hr@estoo.net
Updated 3/2011
Employer’s Name, Address and Telephone #:
Supervisor’s Name and Title:
Your Job Title:
Reason for leaving:
Salary: Beginning Ending or present
Description of Duties:
Employer’s Name, Address and Telephone #:
Supervisor’s Name and Title:
Your Job Title:
Reason for leaving:
Salary: Beginning Ending or present
Description of Duties:
Employer’s Name, Address and Telephone #:
Supervisor’s Name and Title:
Your Job Title:
Reason for leaving:
Salary: Beginning Ending or present
Description of Duties:
Phone Number
Years Known
Employer’s Name, Address and Telephone #:
Dates employed
From (mo/yr): To (mo/yr):
Supervisor’s Name and Title:
Your Job Title:
Reason for leaving:
Salary: Beginning Ending or present
Description of Duties:
Updated 3/2011
The Indian Preference Policy (Resolution 021011-R-03) states “Legally enrolled Eastern Shawnee Tribal members shall be given
preference if the Tribal member’s experience, qualifications, training, and all other criteria included in the job posting are equal.
Tribal Members or Citizens of other Federally Recognized Tribes shall have second preference following the same criteria,
followed by any other applicants.
Are you a member of or eligible for membership in a federally recognized Tribe?
If yes, which Tribe? ________________________________
Can you furnish a “Certificate of Degree of Indian Blood” (CDIB) card, from a federally recognized Tribe?
Verification of Native American heritage must be included with the application in order for Indian Preference
to be considered a factor in the hiring process. If verification is not included, it is not our responsibility to
verify Native American heritage.
Are you legally authorized to work in the U.S.? Verification of identity and Employment Eligibility must be
submitted at the time of hire.
Have you been fired or asked to resign from a job within the past 10 years?
Have you been convicted of a felony in a civilian or military court whether expunged, annulled or sealed? Your
case will be considered in relationship to the requirements of a particular job. If yes, provide details including
dates, court and crime.
Have you ever served in the Armed Forces? If yes, give dates, branch and type of discharge received from
military service.
Are you now working for, or have you ever previously worked for, the Eastern Shawnee Tribe of Oklahoma or its
entities? If yes, when and where?
Do you or your spouse have any relatives presently working for, or holding office in the Eastern Shawnee Tribe
of Oklahoma or one of its entities? (Tribal policy prohibits or limits the hiring of relatives of tribal employees or
officials in certain circumstances.) If yes, give name(s) of relative(s).
If employed and under 18, can you furnish as work permit?
Remarks or Additional Information:
I certify that all of the answers in this application are true, complete and correct. I agree that my employment is based on the
facts that I have given; I therefore authorize investigation of all statements contained in this application for employment as may
be necessary to arrive at an employment decision.
I give the Tribe my permission to contact any former employer, school, college or university, utility company, credit or finance
bureau, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering any
information, personal or otherwise, that such sources may have about my character, general reputation, health credit,
education or employment record, & I give my consent to any such source to release to the Tribe whatever information they
have about me. I also unconditionally release all named & unnamed sources from any & all liability which might result from
furnishing any information about me.
I understand and agree that any false, misleading, or incomplete information in my application, interviews, and/or other pre-
employment questionnaires and procedures, regardless of when discovered by the tribe will be sufficient basis for my
disqualification from employment, or if employed, the termination of my employment. I agree that the tribe shall not be held
liable in any respect if I am not hired or my employment is terminated as a result of providing such false, misleading or
incomplete information.
I understand, also, that I am required to abide by all rules and regulations of the organization applying to. I understand that the
acceptance of this application does not constitute an employment contract.
Updated 3/2011
The Eastern Shawnee Tribe of Oklahoma and its entities maintain a drug free work place. All applicants and employees are
subject to drug and alcohol testing (test), which includes pre-employment and may include for cause, post-accident and
random testing. Your signature on this application signifies that you give your consent to be tested and your consent to the
release of the test results to the Eastern Shawnee Tribe of Oklahoma or its entities for drugs or alcohol according to applicable
policy. A positive test result or failure to submit to a test may lead to immediate employment termination. Applicant
acknowledges that they may/may not be exposed to second hand smoke in their work environment.
The applicant further acknowledges and agrees that if he/she has previously been employed by the Eastern Shawnee Tribe and
/ or its entities, the Eastern Shawnee Tribe of Oklahoma and or its entities may release any and all personnel records of the
applicant to the Eastern Shawnee Tribe of Oklahoma and or its entities to which the Applicant submits an application. By
submitting this application, the Applicant for himself/herself, her/his spouse, legal representatives, heirs and assigns, hereby
releases, waives, holds harmless , and discharges the Eastern Shawnee Tribe of Oklahoma and its entities, their officers and
agents, and each of them, from all liability to the Applicant, her/his spouse, legal representative, heirs and assigns, for any and
all loss or damage, and any claim or damages resulting from the release of any and all of the Applicant’s personnel records to
the Eastern Shawnee Tribe of Oklahoma and / or its entities.
I have read the above and understand it.
Signature of Applicant Date