HOPI TRIBE
HUMAN RESOURCES
PO BOX 123, KYKOTSMOVI, AZ 86039
OFFICE: (928)734-3212
FAX: (928)734-6611
APPLICATION FOR EMPLOYMENT
Job Announcement #
Last Name First Name MI
Mailing Address City State Zip Code
Previous Address City State Zip Code
E-Mail Address
Are you at least 18 years old? Yes No Are you authorized to work in the United States? Yes No
Do you have a valid Arizona Drivers License? Drivers Lic. # Exp. DateYes No
Do you have a Commercial Drivers License? Drivers Lic. # Exp. DateYes No
Do you claim Veteran's preference? (A copy of DD214 must be submitted with the application)Yes No
Do you claim Hopi Tribe preference? Village (Proof of enrollment must be submitted with the application)
Do you claim Indian Preference? Tribe (Proof of enrollment must be submitted with the application)
Do you understand Hopi or Tewa? Do you speak Hopi or Tewa?Yes Yes NoNo
Census #
Are you currently employed with the Hopi Tribe? Have you ever been employed by the Hopi Tribe?
NoYes Yes No
Do you have any relatives currently employed with the Hopi Tribe? If Yes, please list below.Yes No
HUMAN RESOURCES USE ONLY
Received By Date
Assessed By Date
Accepted Rejected
Position Applying for
Phone Number Phone Number
Reason Rejected
**Please complete all sections and sign this form. Incomplete or illegible applications will not be processed.
PRINT OR TYPE CLEARLY
NoYes
NoYes
EQUAL OPPORTUNITY EMPLOYER
EDUCATION HISTORY
If additional space is required please use a blank paper and include your information, attach to the application as EDUCATION HISTORY
*Copies of degrees/diplomas/transcripts/certificates must be attached for educational background to be considered during the screening and
interview process.
Yes No
School Name Dates Attended Hrs Earned Degree or Certificate Graduation Date
Special Qualifications/Skills: List any special skills, i.e, typing/shorthand (wmp), computer skills, special tools & equipment you can
operate, training, and licenses.
List your work record for the last 10 years. Begin with your present or most recent experience and work your way backwards. If jobs
held prior to 10 years ago relate to the position you are applying for, list those also. If you held more than one position within the same
organization list each separately, i.e. military service.
WORK HISTORY
If additional space is required please use a blank paper and include your information, attach to the application as WORK HISTORY
Current or Last Employer
Mailing Address City State Zip Code
Dates of Employment From To Starting Salary Ending Salary
Duties and Responsibilities
Were you a supervisor? If so, please list the number of staff supervised? Yes No
Please List Reason for Leaving
Job Title Supervisor Name
Phone Number
Do you have a High School Diploma or GED?
WORK HISTORY (cont.)
Current or Last Employer
Mailing Address City State Zip Code
Job Title Supervisor Name
Dates of Employment From To Starting Salary Ending Salary
Duties and Responsibilities
Were you a supervisor? If so, please list the number of staff supervised? Yes No
Please List Reason for Leaving
Were you a supervisor? If so, please list the number of staff supervised?
Please List Reason for Leaving
Yes No
Dates of Employment From To Starting Salary Ending Salary
Job Title Supervisor Name
Mailing Address City State Zip Code
Current or Last Employer
Phone Number
Phone Number
Duties and Responsibilities
Applicant Consent to Release Liability and Reference Information
I, _____________________________ (print name), in consideration of employment with the Hopi Tribe, hereby authorize the
Hopi Tribe to perform background checks, reference checks and employment verifications on me. These checks may include, but
are not limited to discussions with: supervisors, coworkers, business associates, or any other party who the Hopi Tribe may use
sole discretion believes may have relevant job related information regarding my suitability for employment. The Hopi Tribe may
also verify information that I have provided on the completed employment application and/or resume.
I agree not to assert any demands, damages, claims, suits or causes of action of any kind against the Hopi Tribe, its offenders,
employees, agents or the organizations, officers, employees, and agents contacted arising out of the Hopi Tribe performing a
good faith effort to check my employment references.
I acknowledge that my failure to authorize the Hopi Tribe to check my references shall disqualify me from consideration from
employment. I acknowledge, the Hopi Tribe has made no representation that employment will be offered to me upon the
completion of reference checks.
I understand the position I am applying for may require a satisfactory background check.
I acknowledge that employment at the Hopi Tribe may be conditioned upon satisfactory completion of an employment medical
assessment, which may include a screening test for the presence of controlled substances. Continued employment would be
continued upon the successful completion of any additional medical assessments that may be reasonably requested by the Hopi
Tribe. Upon reasonable suspicion, the Hopi Tribe may require that I participate in further urinalysis screening tests for the
presence of controlled substances.
I also acknowledge that if the position requires driving in the course of work, I understand that I will be required to possess a
current and valid driver's license and understand that I will be required to provide a copy of my driving record.
I hereby verify, under the penalty of perjury, the information contained in this application is true, correct, and complete to the
best of my knowledge and belief. I am aware that, should an investigation at any time disclose misrepresentation or falsification,
my application will be rejected, and I may be dismissed from employment and disqualified from future employment with the
Hopi Tribe.
A photocopy or facsimile (fax) of this form that shows my signature shall be as valid as the original.
I UNDERSTAND THAT THIS APPLICATION IS VALID ONLY FOR THE POSITION APPLIED.
Applicant's Signature Date
Have you ever been arrested for, charged with, or convicted of a Misdemeanor (other than a minor traffic violation) or Felony?
If you answered yes to the preceding question, for each such charge please list the type of offense, the year charged, the name of
the court, and the disposition of the charge. Criminal convictions or arrests may not automatically disqualify you from
employment, but failure to provide this information will disqualify you.
NoYes
Federal law requires an investigation of the character and criminal background of each individual who is employed, or is being
considered for employment, in a childcare position or a position with duties and responsibilities that involve regular contact with
or control over Indian children pursuant to the Indian Child Welfare Act of 1978 and positions that have regular contact with the
Elderly.
The check shall include a search of the criminal history repositories of all states that an employee or prospective employee lists as
current and former residences in an employment application.
Applicant Consent for Background Information
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The following information is required by law enforcement agencies and other entities for identification
purposes when checking records. It is confidential and will not be used for any other purpose.
PLEASE PRINT or TYPE
Print Full Name Other Names Used
Social Security No. Date of Birth (mm/dd/yyyy)
Applicant's Signature Date