Employment Application. Name: Last First Middle. Home ( ) Alternate( ) Type: i.e. cell phone, message, etc. Social Security No.

Transcription

1 Tribal Lending Enterprise (TLE) a whlly wned Crpratin f the Habematlel Pm f Upper Lake 635 B E. Hwy 20 Upper Lake, CA Cllege Blvd., Ste. 650, Overland Park, KS D: (913) TF: Emplyment Applicatin Please Print Date Name: Last First Middle Hme ( ) Alternate( ) Type: i.e. cell phne, message, etc. Scial Security N. Address: Mailing Address Street Address THE ENTERPRISE IS A NON-SMOKING DRUG FREE ESTABLISHMENT (Initial here) Emplyment Desired Psitins applying fr: Are yu applying fr: Regular full-time wrk? Yes N Regular part-time wrk? Yes N Temprary wrk, e.g., summer r hliday wrk? Yes N Cntinued next page

2 Emplyment Applicatin Page 1 What days and hurs are yu available fr wrk? If applying fr temprary wrk, during what perid f time will yu be available? Frm Are yu available fr wrk n weekends? Yes N Wuld yu be available t wrk vertime, if necessary? Yes N If hired n what date can yu start wrk? Salary desired Persnal Infrmatin Have yu ever applied t r wrked fr Tribal Lending Enterprise (TLE), Habematlel Pm f Upper Lake, Running Creek Casin r any whlly wned Crpratin r Business Enterprise f the Tribe befre? Yes N If yes, when? D yu have any friends r relatives wrking fr Tribal Lending Enterprise., Habematlel Pm f Upper Lake, Running Creek Casin r any whlly wned Crpratin r Business Enterprise f the Tribe? Yes N If yes, state name(s) and relatinship Why are yu applying fr wrk at Tribal Lending Enterprise.? If hired, wuld yu have a reliable means f transprtatin t and frm wrk? Yes N Are yu at least 18 years ld? Yes N (If under 18, hire is subject t verificatin that yu are f minimum legal age.) If hired, can yu present evidence f yur U.S. citizenship r prf f yur legal right t live and wrk in this cuntry? Yes N If hired all emplyees are required t apply fr a cnsumer financial services license and pay a nnrefundable fee. Initial Are yu able t perfrm the essential functins f the jb fr which yu are applying? Yes N Cntinued next page

3 Emplyment Applicatin Page 2 If n, describe the functins that cannt be perfrmed. Are yu able t perfrm all ther duties f the jb fr which yu are applying? Yes N If n, describe the functins that cannt be perfrmed. (Nte Hiring may be subject t passing a medical examinatin as well as skill and agility tests.) Have yu ever been cnvicted f a criminal ffense (felny r serius misdemeanr)? Yes N If yes, state nature f the crime(s), when and where cnvicted and dispsitin f the case (Nte: N applicant will be denied emplyment slely n the grunds f cnvictin f a criminal ffense. The nature f the ffense, the date f the ffense, the surrunding circumstances and the relevance f the ffense t the psitin(s) applied fr may, hwever, be cnsidered.) Are yu currently emplyed? If s, may we cntact yur emplyer? Yes N Yes N Educatin, Training and Experience N. f Years Did yu Degree r Schl Name and Address Cmpleted Graduate? Diplma High Schl Cllege/University Vcatinal/ Business Yes N Yes N Yes N Many f ur custmers (clients) d nt speak English. D yu speak, write r understand any freign languages? Yes N If yes, which languages(s)? Cntinued next page

4 Emplyment Applicatin Page 3 D yu have any ther experience, training, qualificatins r skills which yu feel make yu especially suited fr wrk at ne f the Tribal Cnsumer Financial Services Enterprises r as a Tribal Cnsumer Financial Services Regulatr? If s, please explain Answer the fllwing questins if yu are applying fr a prfessinal psitin Are yu licensed/certified fr the jb applied fr? Yes N Name f License/Certificatin Issuing state License /certificatin number Has yur license/certificatin ever been revked r suspended? Yes N If yes, state reasn(s), date f revcatin r suspensin and date f reinstatement Emplyment Histry List belw all present and past emplyment starting with yur mst recent emplyer (Last 10 years is sufficient). Accunt fr all perids f unemplyment. Yu must cmplete this sectin even if attaching a resume. Name f Emplyer Address Type f Business Telephne N. ( ) Supervisr s Name Yur Psitin and Duties Date f Emplyment: Frm Weekly Pay: Starting T Ending Reasn fr leaving: Name f Emplyer Address

5 Emplyment Applicatin Page 4 Type f Business Telephne N. ( ) Supervisr s Name Yur Psitin and Duties Date f Emplyment: Frm Weekly Pay: Starting T Ending Reasn fr leaving: Name f Emplyer Address Type f Business Telephne N. ( ) Supervisr s Name Yur Psitin and Duties Date f Emplyment: Frm Weekly Pay: Starting T Ending Reasn fr leaving: Name f Emplyer Address Type f Business Telephne N. ( ) Supervisr s Name Cntinued next page

6 Emplyment Applicatin Page 5 Yur Psitin and Duties Date f Emplyment: Frm Weekly Pay: Starting T Ending Reasn fr leaving: Military Service ** Attach additinal page(s) if necessary. ** Have yu btained any special skills abilities as the result f service in the military? Yes N If s, describe: References List belw three persns nt related t yu, that we may cntact. Wh have knwledge f yur wrk perfrmance within the last three years. Name Address Occupatin Telephne N. ( ) Number f Years Acquainted Name Address Occupatin Telephne N. ( ) Number f Years Acquainted Name Address Occupatin Telephne N. ( ) Number f Years Acquainted

7 Emplyment Applicatin Page 6 Authrizatin I certify that the facts cntained in this applicatin are true and cmplete t the best f my knwledge and understand that, if emplyed, falsified statements n this applicatin shall be grunds fr dismissal. I authrize investigatin f all statements cntained herein and the references and emplyers listed abve t give yu any infrmatin cncerning my previus emplyment and pertinent infrmatin they may have persnal r therwise and release Tribal Lending Enterprise and r ne f its whlly wned subsidiaries and r Habematlel Pm f Upper Lake frm all liability fr any damage that may result frm utilizatin f such infrmatin. I als understand and agree that n representative f the Tribal Lending Enterprise. And r ne f its whlly wned subsidiaries and r Habematlel Pm f Upper Lake has any authrity t enter int any agreement fr emplyment fr any specific perid f time, r t make any agreement cntrary t the freging, unless it is in writing and signed by an authrized Tribal Lending Enterprise r Habematlel Pm f Upper Lake representative. Applicant Signature Date T be cmpleted by applicant: Equal Emplyment Opprtunity Data Cmpletin f this frm is entirely vluntary and all infrmatin will remain cnfidential and will nt affect yur applicatin fr emplyment. We are required by law t cllect this infrmatin fr equal pprtunity emplyment purpses and it will nt becme part f yur persnnel recrd if yu are hired by this cmpany. Name: Sex Male Female Race/Ethnicity: American Indian/Alaskan Native Asian/Pacific Islander Black Hispanic White Gvernment cntractrs must take affirmative actin t emply and advance certain qualified individuals subject t the Rehabilitatin Act f 1973 and the Vietnam Era Veterans Readjustment Act f Cmpletin f the fllwing infrmatin is vluntary and will assist us in prper placement and reasnable accmmdatin. If yu wish t be identified as qualifying fr such placement r accmmdatin, please check where applicable: Vietnam Era Veteran Disabled Veteran Individual with a Disability

8 Emplyment Applicatin Page 7 T be cmpleted by emplyer: EEO-1 Categry: 1. Officials and managers 2. Prfessinals 3. Technicians 4. Sales 5. Office and clerical 6. Crafts skilled 7. Operatives semi-skilled 8. Labrers unskilled 9. Service wrkers Emplyer infrmatin cmpleted by: Name: Date: Emplyment Applicatin Page 8