Fillable NEW EMPLOYEE HIRE CHECKLIST (Santa Rosa Band of Cahuilla Indians)

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NEW EMPLOYEE HIRE CHECKLIST (Santa Rosa Band of Cahuilla Indians)

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NEW EMPLOYEE HIRE
CHECKLIST
EMPLOYEE:
1. NEW HIRES
☐ Job Application
☐ Job Description
☐ Copy of Valid Driver’s License. DL:_______________ Exp. _______________
☐ Copy of Social Security Card
☐ Copy of Valid Vehicle Insurance.
☐ Copy of DMV Report
☐ Confidentiality Agreement
☐ 1-9 Form
☐ W-4 Form
☐ Copy of HS Diploma/GED.
☐ Drug test results/receipt
☐ Background Check results/receipt
☐ Employee Acknowledgement Form
☐ Direct Deposit (optional)
☐ Memorandum of Conditional Hire: Driver License
☐ Memorandum of Conditional Hire: HS Diploma/GED
☐ Offer Letter
☐ Copy of CPR: Exp: ___________
__________________________________________ _________________________
Administration Verifier Date
Page 1 of 3
DO YOU HAVE A HIGH SCHOOL DIPLOMA/GED?
Yes
NO
DO YOU HAVE A VALID DRIVER'S LICENSE?
Yes
ARE YOU ABLE TO PASS BACKGROUND CHECK?
Yes
NO
ARE YOU ABLE TO PASS DRUG TEST?
Yes
NO
EMPLOYMENT APPLICATION
P.O. Box 391820, Anza, CA 92539
Phone: 951-659-2700 Fax: 951-659-2228
Position Applying For:
Please return completed application before or on deadline to
webmaster@santarosa-nsn.gov
APPLICANT INFORMATION
NAME (First, Middle, Last)
MAILING ADDRESS
CITY
STATE
ZIP
HOME NUMBER
CELL NUMBER
DATE YOU CAN START
DESIRED SALARY
EMAIL ADDRESS
EDUCATION
Please list any education or training you feel relates to the position applied for that would help you
perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.
School Name
Degree
Address/City/State
High School
College
College
Other
WHY DO YOU WANT TO WORK FOR THE TRIBE?
Explain in detail why you want this job.
Page 2 of 3
SPECIAL SKILLS
List any special skills or experience that you feel would help you in the position that your are
applying for (leadership, certifications, organizations/teams, etc.)
CAREER PLANS
In what way does this position fit into your overall career plans?
PROFESSIONAL ASSETS
What are your professional assets that would be of value as an employee of Santa Rosa?
mber
1
2
3
Name
Address/City/State
Phone
Email Address
Relationship
REFERENCES
Please list three professional references not related to you, with full name, address, phone nu
and relationship. If you don't have three professional references, then list personal, unrelated references.
Page 3 of 3
May we contact your most recent employer?
Yes No
WORK HISTORY
Start with your present or most recent employment and work back. Use separate sheet if necessary.
JOB TITLE
Start Date (mo/day/yr.)
End Date (mo/day/yr.)
Company Name
Supervisor's Name
Phone Number
Address
City/State/Zip
Duties:
Reason for Leaving
Starting Salary
Ending Salary
JOB TITLE
Start Date (mo/day/yr.)
End Date (mo/day/yr.)
Company Name
Supervisor's Name
Phone Number
Address
City/State/Zip
Duties:
Reason for Leaving
Starting Salary
Ending Salary
JOB TITLE
Start Date (mo/day/yr.)
End Date (mo/day/yr.)
Company Name
Supervisor's Name
Phone Number
Address
City/State/Zip
Duties:
Reason for Leaving
Starting Salary
Ending Salary
JOB TITLE
Start Date (mo/day/yr.)
End Date (mo/day/yr.)
Company Name
Supervisor's Name
Phone Number
Address
City/State/Zip
Duties:
Reason for Leaving
Starting Salary
Ending Salary
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required
employment eligibility verification form upon hire. 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.
Applicant Signature Date
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NEW EMPLOYEE HIRE CHECKLIST (Santa Rosa Band of Cahuilla Indians)

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Completed 27 January 2021

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