NHBP Job Application

NHBP Job application First Name: Address: City: Phone number: (h) (Cell) Fax: SSN: Drivers License Number: Email: State: (w) Zip: Middle Last 1. Position you are applying for: 2. Wage range that you are seeking for this position: 3. Do you give us permission to contact your current employer? (check one) ( ) I would prefer that you not contact my current employer; they do not know I am looking other employment. ( ) I give you permission to contact my current employer 4. Current employment status FTE___ PTE___ Unemployed___ Laid Off___ 5. Name of Current Employer: Address: Phone Number: Fax Number: Month and year employment began: Where there any job related disciplinary actions during your time as an employee here? Please list the nature of that disciplinary action and its resolution: Note: any misrepresentation, including omissions, made on the application can result in refusal to hire, or discharge at any time. 1 NHBP Job application 6. Please list all prior employment history for the last ten years: Name of Employer: Address: Phone Number: Fax Number: Month and year employment began and ended: _______--________ When I left this employer I: ( ) was laid off ( ) resigned ( ) resigned in lieu of discharge ( ) discharged ( ) retired Where there any job related disciplinary actions during your time as an employee here? Please list the nature of that disciplinary action and its resolution: Name of Employer: Address: Phone Number: Fax Number: Month and year employment began and ended: _______--________ When I left this employer I: ( ) was laid off ( ) resigned ( ) resigned in lieu of discharge ( ) discharged ( ) retired Where there any job related disciplinary actions during your time as an employee here? Please list the nature of that disciplinary action and its resolution: Name of Employer: Address: Phone Number: Fax Number: Month and year employment began and ended: _______--________ When I left this employer I: ( ) was laid off ( ) resigned ( ) resigned in lieu of discharge ( ) discharged ( ) retired Where there any job related disciplinary actions during your time as an employee here? Please list the nature of that disciplinary action and its resolution: Note: any misrepresentation, including omissions, made on the application can result in refusal to hire, or discharge at any time. 2 NHBP Job application Name of Employer: Address: Phone Number: Fax Number: Month and year employment began and ended: _______--________ When I left this employer I: ( ) was laid off ( ) resigned ( ) resigned in lieu of discharge ( ) discharged ( ) retired Where there any job related disciplinary actions during your time as an employee here? Please list the nature of that disciplinary action and its resolution: (Use the reverse side if more space is needed and answer with the same format) 7. Please list your educational history: Name of School: Years attended: Degree or diploma attained: Name of School: Years attended: Degree or diploma attained: (Use the reverse side if more space is needed and answer with the same format. Please attach copies of diplomas, degrees, and certifications) 8. On a separate sheet of paper please list five references; three must be professional or employers. Include address, phone and fax number, and email if available. 9. Please describe your attendance record at your last job: 10. Have you had any criminal convictions including pleas of nolo contendere? ( ) Yes ( ) No If yes please explain: Note: any misrepresentation, including omissions, made on the application can result in refusal to hire, or discharge at any time. 3 NHBP Job application 11. Do you have any pending felony charges? ( )Yes ( ) No If yes please explain: 12. Are you a veteran of the armed services? ( )Yes ( ) No Were you honorable discharged? ( ) Yes ( )No If no please explain: 13. Have you ever had a denial of application for any professional or any other license of certification? ( )Yes ( ) No If yes please explain: 14. Have you ever had any professional or any other license or certification suspended or revoked? ( )Yes ( ) No If yes please explain: 15. Are the current professional or any other license(s) or certifications you hold under investigation? ( )Yes ( ) No If yes please explain: 16. Are the current professional or any other license(s) or certifications you hold restricted, probationary, or under any disciplinary action? ( )Yes ( ) No If yes please explain: 17. If you are hired for this position when would you be available to start work? 18. Given what you know of the position description for the job you are applying for can you perform all job related functions, with or with out reasonable accommodations? ( ) yes ( ) no What reasonable accommodations might you need? 19. Are you legally eligible to work in the United States of America? ( ) yes ( ) no Note: any misrepresentation, including omissions, made on the application can result in refusal to hire, or discharge at any time. 4 NHBP Job application Please read the following notices completely and carefully and then sign: I (name) _______________________ give the Nottawaseppi Huron Band of Potawatomi (NHBP) tribe permission to verify the information contained in this application for employment, and to check my qualifications, background, and medical job related history. I understand that NHBP will do drug and alcohol testing upon employment and may do random screens, reasonable suspicion testing and post-accident screens I understand that the Nottawaseppi Huron Band of Potawatomi (NHBP) tribe is an at-will employer and as such the employment relationship can be terminated at any time and for any reason or no reason. NHBP’s at-will status cannot be changed absent a written agreement with the NHBP Tribe I understand that all information regarding clients, members, or tribal business is confidential and all confidential information is on a “need to know” basis. I further understand that NHBP has a code of ethics that staff must adhere to; any violation of ethics or confidentiality can result in termination. I understand that email, email passwords, computer files and passwords and all electronic correspondence are the property of NHBP and are not to be considered personal, private, or confidential. NHBP has the right to monitor email and internet use and all passwords must be recorded with NHBP. I understand that NHBP does not engage in or tolerate discrimination or harassment based on race, national origin, sex, age, disability, weight, height, or pregnancy. There is zero tolerance for workplace violence, threats, and intimidation. No weapons may be brought into NHBP office or to NHBP events or transported in NHBP vehicles. The NHBP personnel policy covers these issues more in-depth and all employees are required to read and understand this document. I have read and agree to the above notices: Signature: ___________________________ Witness: _____________________________ Date: __________________ Date: __________________ Note: any misrepresentation, including omissions, made on the application can result in refusal to hire, or discharge at any time. 5