Fillable Employment Application (.PDF) (Cheyenne and Arapaho Tribes)

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Employment Application (.PDF) (Cheyenne and Arapaho Tribes)

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CHEYENNE and ARAPAHO TRIBES
P.O.
BOX 38
C
ONCHO, OK 73022
(405) 262-0345
PERSONAL INFORMATION Date of Application _______________
Name __________________________________________________ Date of birth ___________
Last First Middle Initial
Address ____________________________________________________________________________
Street/P.O. Box City State Zip Code
Social Security Number __________________ E-mail address ________________________________
Telephone number(s) Main ____________________ Alternate ____________________
Are you an enrolled member of the Cheyenne and Arapaho Tribes? Yes No
Are you a member of a different federally-recognized Native American Tribe? Yes No
Have you ever lived or worked on a Native American reservation? Yes No
Are you under 18 years of age? (If you are under 18 you may be required to provide a work permit.) Yes No
If hired can you provide verification of your legal right to work in the United States? Yes No
EMPLOYMENT INTERESTS
Specific position for which you are applying _________________________________________________
If not applying for a specific position, what type of work are you interested in? ______________________
Minimum acceptable pay $ _______ per _______ When would you be available to start? ___________
What type of appointment(s) are you willing to accept?
Permanent, full-time Temporary, full-time
Permanent, part-time Temporary, part-time
If part-time, how many hours per week can you work? ______
Within the last five (5) years have you been fired or forced to resign from a job? Yes No
If yes, under what circumstances? _____________________________________________________________
MILITARY SERVICE
Have you served in the Armed Forces of the United States? Yes No
If yes, what branch of service? _______________________ Last Rank __________________________
Brief description of military duties
____________________________________________________________________________________
____________________________________________________________________________________
Type of Discharge ____________________ Date of Discharge __________________ (Attach form DD214)
Are you a member of the National Guard or Reserves? Yes No
EMPLOYMENT
Reset Form
PERSONAL REFERENCES
1. Name ______________________________________________________ Years known ____
Address _____________________________________________________________________
Street/P.O. Box City State Zip Code
Occupation ___________________________ Telephone number ____________________
2. Name ______________________________________________________ Years known ____
Address _____________________________________________________________________
Street/P.O. Box City State Zip Code
Occupation ___________________________ Telephone number ____________________
3. Name ______________________________________________________ Years known ____
Address _____________________________________________________________________
Street/P.O. Box City State Zip Code
Occupation ___________________________ Telephone number ____________________
EDUCATION
Name and location of High School ________________________________________________________
Did you graduate? Yes No If yes, what year? __________
Have you received your GED? Yes No If yes, what year? __________ (Provide copy of GED certificate)
If no, list the last year (grade) completed _______
College/University name and location ____________________________________________
Have you graduated? Yes No If yes, what year? __________ (Provide copy of degree)
If no, give expected graduation date _________ Last year completed __________
Major ______________________________ Minor ________________________________
Vocational/Technical school and location ___________________________________________________
Last year completed ____________ Have you graduated? Yes No (Provide copy of certification)
If yes, what year _____________ If no, give expected graduation date __________________
Other training ________________________________________________________________________
Last year/session completed ______________ Have you graduated/finished? Yes No
Major/subject studied _________________________________________________________
Do you hold any other licenses or certificates? Yes No
________________________________ ___________________________________
License or Certificate Licensing Authority
If required by the job do you have a valid driver’s license? Yes No
Typing Yes No Words per minute ______
Are you computer literate/able to operate a computer? Yes No
If yes, list programs you are familiar with ___________________________________________________
Other skills __________________________________________________________________________
Additional information __________________________________________________________________
EMPLOYMENT EXPERIENCE
1. Employer name ____________________________ Telephone ______________________
Address ___________________________________________________________________
Street/P.O. Box Town/City State Zip Code
Last position held _____________________________ Pay rate $_____ per ________
Employment period: From _______________________ To _________________________
May we contact? Yes No Name and Title of Supervisor _______________________________
Brief Description of Duties
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________
2. Employer name ____________________________ Telephone ______________________
Address ___________________________________________________________________
Street/P.O. Box Town/City State Zip Code
Last position held _____________________________ Pay rate $_____ per ________
Employment period: From _______________________ To _________________________
May we contact? Yes No Name and Title of Supervisor _______________________________
Brief Description of Duties
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________
3. Employer name ____________________________ Telephone ______________________
Address ___________________________________________________________________
Street/P.O. Box Town/City State Zip Code
Last position held _____________________________ Pay rate $_____ per ________
Employment period: From _______________________ To _________________________
May we contact? Yes No Name and Title of Supervisor _______________________________
Brief Description of Duties
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Reason for Leaving ____________________________________________________________________
BACKGROUND INFORMATION
For all questions, provide all additional required information in the space provided or on a separate sheet.
Ensure full name and social security number is on an attachment(s) to this application.
1) In the last five years, have you been arrested for, charged with, convicted of, been imprisoned, been
on probation, or been on parole for any offense(s)? Include all offenses where you have been found guilty,
pled guilty or nolo contendere (no contest). (Leave out traffic fines of less than $150.00.) Yes No
2) Have you been convicted of a felony within the last five years? Yes No
3) Have you been convicted by a military court-martial in the past five years? Yes No
4) Are you now under charges for any violation of law? Yes No
5) During the last five years, have you been fired from any job for any reason, did you quit after being told
that you would be fired, or did you leave any job by mutual agreement because of specific problems?
Yes No
6) Have you ever been arrested for or charged with a crime involving a child? Yes No
If you have answered yes to any question(s) please give question(s) number and explain below.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
CONSENT FOR DRUG/ALCOHOL TESTING
If you are offered and accept employment with the Cheyenne and Arapaho Tribes of Oklahoma, you will be required to take a urine test for
Drug/Alcohol use as a condition of employment. The purpose of the Drug test is to ensure a Drug Free Working Environment.
I, ______________________________ , have been fully informed by my potential employer of the reason for this urine test for Drug/Alcohol. I
understand what I am being tested for, the procedure involved and freely give my consent. I also understand the results of this test will be sent to my
prospective employer. I authorize these test results to be released to the Cheyenne and Arapaho Tribes, Drug Free Workplace Officer.
___________________________
Signature of Applicant
__________
Date
APPLICANT’S STATEMENT
I certify that all of the statements made in this application are true, complete, and correct to the best of my knowledge and belief. They are made in
good faith. I understand that a false answer to any question in this application may be used as grounds for not employing me, or for dismissing me,
after I begin work.
I hereby authorize any person, school, current employer (except as previously noted), past employers, and organizations named in this application
form (or related documentation or interview) to provide the Cheyenne & Arapaho Tribes Personnel Department with any information and opinion
requested in connection with any application, and I release such persons and organizations from any legal liability for making such statements.
___________________________
Signature of Applicant
__________
Date
Print form and sign.
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AUTHORIZATION FOR RELEASE OF INFORMATION FOR APPLICANT’S APPLYING FOR POSITIONS
INVOLVING INTERACTION WITH MINORS.
I authorize any investigator, or other duly accredited representative of the agency conducting my background investigation, to obtain any information
relating to my activities from individuals, schools, residential management agents, employers, criminal justice agencies, or other sources of
information. This information may include, but is not limited to, my academic, residential, achievement, performance, attendance, disciplinary,
employment history, and criminal history record information.
I further authorize any investigator, or other duly accredited representative of the Cheyenne and Arapaho Tribes, who is conducting my background
investigation, to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for
assignment to, or retention in a position working with children. I understand that I may request a copy of such records as may be available to me
under the law.
I authorize custodians of records and other sources of information pertaining to me to release such information upon request of the investigator, or
other duly accredited representative authorized above regardless of any previous agreement to the contrary.
I understand that the information released by records custodians and sources of information is for official use by Cheyenne and Arapaho Tribes and
only for the purpose of determining my suitability for employment with the Cheyenne and Arapaho Tribes.
Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for five (5) years from
the date signed or upon the termination of my affiliation with the Cheyenne and Arapaho Tribes, whichever is sooner.
__________________________ ______________________
Other names used Social Security number
__________________________ ______________________
Position for which you are being investigated Primary contact telephone number
_____________________________________________ ______________________
Current Address Secondary contact telephone number
_________ ______________________
Date Signed Print or type name
______________________
Signature (sign in black ink)
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Employment Application (.PDF) (Cheyenne and Arapaho Tribes)

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Completed 20 July 2020

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