EMPLOYMENT APPLICATION

Full Name*

Last NameFirst NameMiddle Initial

Date*

Date

Address*

Street Address Apt/ Unit #

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone*

Email*

example@example.com

Date Available*

Date

Social Security No.*

Desired Salary.$*

Position Applied for:*

Are you a citizen of the United States?*

YESNO

If no, are you authorized to work in the U.S.?

YESNO

Have you ever worked for this company?*

YESNO

If yes, when?

Have you ever been convicted of a felony?*

YESNO

If yes, explain:

Are you a member of the Absentee Shawnee Tribe?*

YESNO

(Attach tribal identification for Indian preference)

File Upload

If you are a member of a federally recognized tribe please list Tribe here:

Tribal Affiliation

Are you related to any Executive Committee member of the Absentee Shawnee Tribe or Board of Commissioner of Absentee Shawnee Housing Authority?*

YESNO

List name of relative here:

Name of Relative

High School*

Address*

From*

To*

Did you graduate?*

YESNO

Diploma

College

Address

From

To

Did you graduate?

YESNO

Degree

Other

Address

From

To

Did you graduate?

YESNO

Degree

Full Name*

Relationship*

Company*

Phone*

Address

Full Name*

Relationship*

Company*

Phone*

Address

Full Name*

Relationship*

Company*

Phone*

Address

Company*

Phone*

Address

Supervisor*

Job Title*

Starting Salary.$*

Ending Salary:$*

Responsibilities*

From*

To*

Reason for Leaving;*

May we contact your previous supervisor for a reference?*

YESNO

Company*

Phone*

Address

Supervisor*

Job Title*

Starting Salary.$*

Ending Salary:$*

Responsibilities*

From*

To*

Reason for Leaving*

May we contact your previous supervisor for a reference?*

YESNO

Company

Phone

Address

Supervisor

Job Title

Starting Salary.$

Ending Salary.$

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YESNO

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

Application Waiver and Signature

PLEASE READ THE FOLLOWING STATEMENT CAREFULLY

In exchange for the consideration of my job application by the ABSENTEE SHAWNEE HOUSING AUTHORITY (hereinafter called "the Company"), / 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 the contents of employee handbooks, personnel manuals, benefits plan, policy statements, and the like as they may exist form 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 exceptbya 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, / understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits / authorize investigation of all statements contained in this application / understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. / hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and other, and hereby release the Company from any liability as a result of such contact. / also understand that 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. / further understand that continued employment may be based on successful passing of job-related physical examination / 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 by 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 / 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. 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 opportunity employer; however, preference is given to qualified Native American applicants as allowed by regulations. We adhere to policy for making employment decisions without regard to race, color, religion, sex sexual orientation, national origin, citizenship, age or disability. We assure that your opportunity for employment with us depends solely on your qualifications

Signature*

Date*

Date

EMPLOYMENT APPLICATION FORM

EDUCATION

REFERENCES

PREVIOUS EMPLOYMENT

MILITARY SERVICE