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PECHANGA TRIBAL GOVERNMENT (Pechanga Tribal Government)

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HR EMP APP 3/2015
PERSONAL INFORMATION
Full Name:
Date:
Home Phone:
Cell Phone:
Email:
Preferred mode of contact: ☐cell ☐home ☐email
Address:
State name and relationship of any relatives in our employ:
Referred by:
☐Pechanga Band of Luiseño Mission Indians Members
☐Pechanga Band of Luiseño Mission Indians Member’s Spouse
☐Other American Indian: Tribe name
Hiring Preference: The Pechanga Tribal Government will at all times and for all positions give hiring, transfer and promotion
preference to qualified applicants in the following order: 1) Pechanga Band of Luiseño Mission Indians Members; 2) Pechanga
Band of Luiseño Mission Indian Member Spouses; 3) Other American Indians; and 4) all others.
EMPLOYMENT INTERESTS
Position applying for:
Have you previously applied for a position with The Pechanga Tribal Government? ☐Yes ☐No
If yes, list date and position applied for:
Have you ever held a position with any Pechanga entity?
☐Yes ☐No
If yes, which entity?
If yes, list dates and position held:
Are you eligible for rehire? ☐Yes ☐No
Available start date:
Salary desired:
Are you employed now? ☐Yes ☐No
May we contact your current employer? ☐Yes ☐No
EDUCATION
School or Institution
Name and Location
Major
Degree/Diploma
High School
College/University
Other
Special Training/Affiliations: Exclude organizations: the name or character of which indicate the race, creed, sex, marital status, age, color or
national origin of its members.
PECHANGA TRIBAL GOVERNMENT
EMPLOYMENT APPLICATION
Only typed applications accepted
2
HR EMP APP 3/2015
Honors or Awards Received:
Professional Certificates/Licenses held:
EMPLOYMENT HISTORY
List your last four employers, starting with the most recent
Company Name:
Address:
Telephone:
Dates Employed (Month/Year)
From:
Job Title:
Supervisor’s Name/Title:
Type of Business:
Dates Employed (Month/Year)
To:
Description of Duties:
Reason for Leaving:
May we contact this employer?
☐ Yes
☐No
Company Name:
Address:
Telephone:
Dates Employed (Month/Year)
From:
Job Title:
Supervisor’s Name/Title:
Type of Business:
Dates Employed (Month/Year)
To:
Description of Duties:
Reason for Leaving:
May we contact this employer?
☐ Yes
☐No
Company Name:
Address:
Telephone:
Dates Employed (Month/Year)
From:
Job Title:
Supervisor’s Name/Title:
Type of Business:
Dates Employed (Month/Year)
To:
Description of Duties:
Reason for Leaving:
May we contact this employer?
☐ Yes
☐No
Company Name:
Address:
Telephone:
Dates Employed (Month/Year)
From:
Job Title:
Supervisor’s Name/Title:
Type of Business:
Dates Employed (Month/Year)
To:
Description of Duties:
Reason for Leaving:
May we contact this employer?
☐ Yes
☐No
OTHER INFORMATION
Have you ever been terminated or asked to resign from any job? ☐Yes ☐No If yes, please explain.
Have you ever been convicted of a felony? ☐Yes ☐No If yes, please provide information regarding
conviction including state, city or county where the offense occurred. NOTE: Answering “yes” to this question may
not adversely affect your application for employment. Factors such as age, time and nature of offense will be considered.
Are you at least 18 years of age or older? ☐Yes ☐ No If no, you may be required to provide authorization to work.
3
HR EMP APP 3/2015
Do you have the legal right to work and be employed in the U.S.? ☐Yes ☐No
(Proof of identity and legal authority to work in the U.S. is a condition of employment)
Do you have reliable transportation to and from work? ☐Yes ☐No
Are you willing to work overtime, if necessary? ☐Yes ☐No
Do you understand the job requirements? ☐Yes ☐ No
Are you able to perform the essential functions of the position for which you are applying, either with or
without reasonable accommodations? ☐Yes ☐No
List languages, other than English, in which you are fluent:
1.
☐Speak
☐Read
☐Write
2.
☐Speak
☐Read
☐Write
List all computer software programs you are proficient with:
Ability to type? ☐Yes ☐No
Words per minute:
PROFESSIONAL REFERENCES
Please include a minimum of two references
Name
Phone
Email
Business Name/Affiliation
Years
Acquainted
PERSONAL REFERENCES
Please include a minimum of two references
Name
Phone
Email
Affiliation
Years
Acquainted
4
HR EMP APP 3/2015
ACKNOWLEDGEMENT (PLEASE READ CAREFULLY BEFORE SIGNING BELOW):
initials
I hereby affirm that the information provided on this employment application form and my resume is true
and complete to the best of my knowledge. I understand and agree that falsified information or omissions
may result in termination from employment if discovered after my employment has begun. I hereby
authorize the Pechanga Tribal Government (hereinafter referred to as the “Tribe”) to substantiate and verify
my past employment, previous salary history, credentials, and any of the information associated with my
qualifications. I also authorize my previous schools, employers, and listed references to release to the Tribe
any relevant information that may reasonably be requested in connection with my employment. I agree that
the Tribe and my previous employers, schools and references shall not be held liable if an employment offer
is not tendered, is withdrawn, or employment is terminated due to any false information I provided or
information I failed to provide.
initials
I understand that any employment offer I might receive is contingent upon my passing both a drug and
alcohol test and background screening. I consent to any testing necessary to determine the presence and/or
level of drugs and alcohol in my body other than drugs prescribed by a physician.
initials
I understand that as a condition of employment in a Director/Manager role or a position in the Finance
department, a Consumer Credit Report may be applicable as part of the background screening process.
initials
I understand that as a condition of employment in positions working directly with children or where children
may be present, additional background screening which may include extensive and specialized screening
will be required.
initials
I understand that no statement in this form, related policies, or any offer of employment may be construed
as an employment contract.
At-Will Employment:
initials
I understand that employment with the Pechanga Tribal Government is at-will and for no definite period.
The employment relationship may be terminated at any time by the employee or the Tribal Government for
any or no reason and with or without notice.
Drug Testing:
initials
I understand that the Pechanga Tribal Government is a drug-free workplace. All employees must pass pre-
employment and other mandatory drug testing pursuant to The Pechanga Tribal Government Employee
Policy and Procedures Manual, Drug Free Workplace Policy.
initials
I understand that my application for employment will be placed in an active status for a period of one (1)
year during which time it will be reviewed as job openings occur in my area(s) of job interest. I understand
that the Tribe may or may not contact me on the status of my application based on my qualifications and
available openings and I should assume that my application has been reviewed. I further understand that if
I wish my application to remain active for a period longer than one (1) year, I must complete a new
application.
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission
of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period
and may, at the discretion of the employer be terminated at any time and for any reason without any previous notice.
Applicant Signature:
Date:
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signature
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PECHANGA TRIBAL GOVERNMENT
Attachment to Employment Application for Fire Department
Directions: Attach a copy of your resume and a copy of any professional licenses and certificates that are
stated in the job announcement/job description for the position that you are applying for and that are shown
in the section below.
Professional License/Certificate Possessed (Attach Copy)
Date Issued
Issued By
Expiration
Current California EMT I Certification or Parmedic Certification
Current CPR Card
CA Accredited Fire Academy or FF I Certification
Confined Space Rescue Awareness Certification
HAZ MAT FRO (8 hrs Fed OSHA) Certification
ICS 1-100 or Greater
Driver Operator 1A and 1B
California State Fire Marshal Firefighter II Certification
California State Fire Marshal Fire Officer’s Certification
& (ICS 300) Qualification
Other:
Summarize other special job related skills and knowledge acquired from employment or other experience that would
help us evaluate your qualifications, i.e. fire explorer, volunteer firefighter, etc.
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PECHANGA TRIBAL GOVERNMENT (Pechanga Tribal Government)

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Completed 11 August 2020

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