Employment Application Form

ABSENTEE SHAWNEE HOUSING AUTHORITY

EMPLOYMENT APPLICATION
By completing this application, you understand and accept that you are applying for a position as an "At Will" employee. "At Will" employment means that either you or the Company can terminate your employment with or without cause and with or without notice.
Name:*

First NameMiddle InitialLast NameSuffix
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years lived there:*
Social Security Number*
Home Phone

Area CodePhone Number
Mobile Phone*

Area CodePhone Number
E-mail Address:*
Emergency Contact*

NamePhoneE-Mail
Are you a member of the Absentee Shawnee Tribe?*

YesNo
Are you a member of a Federally Recognized Indian Tribe?*

YesNo
If "Yes", please list your enrolled tribe below.
Tribal Affiliation
Are you related to any Executive Members of the Absentee Shawnee Tribe or the Absentee Shawnee Housing Authority Board of Commissioners? If yes, list relationship(s) below or enter no.
Are you a U.S. citizen or an alien authorized to work in the United States?*
Do you speak a language other than English? If yes, please list the language(s) below or enter no.
Have you been convicted of a misdemeanor within the last 7 years?*
If yes, please explain:
If yes, please explain.
Have you been convicted of a felony or subjected to a deferred adjudication on a felony charge?*
If yes, please explain:
If yes, please explain.
Have you been issued any moving/traffic violations within the last 3 years?*
If yes, please explain:
If yes, please explain.

If under 18, please list age:
Position Applying Desired*
Salary Desired*
Employment Desired
Are you willing to work other than 8am - 4:30pm?
Are you employed now?
May we contact your present employer?
Have you ever been employed by the Absentee Shawnee Housing Authority?
Date you are available to start work?

MonthDayYear
Date
What dates are you unable to work?
Are you willing to travel?
Do you have any physical limitations that prevent you from fully performing any work for which you are being considered? If yes, please describe below or enter no.
Do you have a current valid drivers license?*
If yes, please state the following:
Driver License Information*

Issuing StateExpiration Date
Do you have a commercial driver's license?*
If yes, please state the following:
CDL Information*

Issuing StateExpiration Date
Have you had any motor vehicle accidents during the past 3 years? If yes, please explain or enter no.

What is the highest grade you completed?
Did you graduate from:
High School Attended
City/State
Graduation
Degree/Major
College Attended
City/State
Graduation
Degree/Major
Business or Trade School
City/State
Graduation
Degree/Major
Professional School
City/State
Graduation
Degree/Major
Typing Skills
WMP
10-Key
Personal Computer
Special Training/Skills/Qualifications: List all job related training or skills you possess and machines or office equipment you can use, such as calculators, printing or graphics equipment, types of software and hardware.
Please provide copies of any certifications or license related to the position for which you are applying.

Military Background
Have you ever been in the Armed Forces?
Are you a member of the National Guard?
Are you a veteran?
If yes, list type of discharge status:
Specialty:
Date Entered

MonthDayYear
Date
Discharge Date

MonthDayYear
Date
Employment Experience

Please include the last 5 years of employment, begin with your most recent job held. Do not write in "Refer to Resume", etc. Resumes may be attached. If you were self-employed give firm name, if you had gaps between jobs please list those.
Current or Most Recent Employer:*
Name of Employer
Employer Phone Number
Phone Number(s)
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment

Dates of EmploymentMost Recent Salary or Hourly Rate
Last Salary
Job Title
Last Position You Held:
Direct Supervisor
Immediate Supervisor(s)
Responsibilities
Job Responsibilities
Recent Employer:*
Name of Employer
Employer Phone Number
Phone Number(s)
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment

Dates of EmploymentMost Recent Salary or Hourly Rate
Last Salary
Job Title
Last Position You Held:
Direct Supervisor
Immediate Supervisor(s)
Responsibilities
Job Responsibilities
Recent Employer:*
Name of Employer
Employer Phone Number
Phone Number(s)
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates of Employment

Dates of EmploymentMost Recent Salary or Hourly Rate
Last Salary
Job Title
Last Position You Held:
Direct Supervisor
Immediate Supervisor(s)
Responsibilities
Job Responsibilities
Did you complete this application yourself?
If not, who did?
References

Please list three references that NOT related to you whom you have known at least 1-5 years:
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:

First NameLast Name
Phone Number

Area CodePhone Number
Years Known:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 3
Name:

First NameLast Name
Phone Number

Area CodePhone Number
Years Known:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Anything else you may want to add/summarize to your qualification to complete this application:

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY APPLICATION FORM WAIVER

In exchange for the consideration of my job application by the ABSENTEE SHAWNEE HOUSING AUTHORITY (hereinafter called "the Company"), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of contents of employee handbooks, personnel manuals, benefits plan, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the ABSENTEE SHAWNEE HOUSING AUTHORITY, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Executive Director of the Company. Both the undersigned and the ABSENTEE SHAWNEE HOUSING AUTHORITY may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact. I also understand the Company (1) has a drug and alcohol policy that may require drug testing; (2) consent to and compliance with such policy is a condition of my employment; (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on successful passing of job-related physical examination. I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigation consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the Company shall be probationary for a period of ninety (90) days and that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at-will for any reason by either party.
Signature*

Clear
Date*

MonthDayYear
Date
Important! In order to be eligible for Indian Preference, a copy of your CDIB or Tribal Enrollment card must be included with your application. The Absentee Shawnee Housing Authority is an equal employment opportunity employer; however preference is given to qualified Native American applicants as allowed by regulations. We adhere to policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with the Company depends solely on your qualifications. Updated: July 8, 2013
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ABSENTEE SHAWNEE HOUSING AUTHORITY

By completing this application, you understand and accept that you are applying for a position as an "At Will" employee. "At Will" employment means that either you or the Company can terminate your employment with or without cause and with or without notice.

Military Background

Employment Experience

References

Reference 1

Reference 2

Reference 3

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY APPLICATION FORM WAIVER