WHITE MOUNTAIN APACHE TRIBE
 Division of Human Resources
Personnel Department
P.O. Box 700 - Whiteriver, AZ 85941
APPLICATION FOR EMPLOYMENT

1. Read all instructions carefully. (please print or type)
2. Fill in all areas requested; if NOT APPLICABLE, write N/A, Do Not leave any spaces blank.
3. Type or print information and fill in information neatly and accurately.
4. Apply BEFORE OR NO LATER than the announced closing date.
5. If additional information is being requested, please supply them with your application.
INCOMPLETE APPLICATIONS WILL BE DELAYED AND MAY AFFECT YOUR CHANCES FOR EMPLOYMENT

ASSISTANCE
Application complete
ONLY
when Required Documentation is Submitted, with this Form.
Applications must have three reference letters attached that are current and one must be from a most recent supervisor.
ASSISTANCE IN FILLING OUT THIS APPLICATION IS AVAILABLE THROUGH THE WHITE MOUNTAIN APACHE TRIBE, DIVISION OF HUMAN RESOURCES, PERSONNEL DEPARTMENT.
* After applications has been stamped and received by personnel, it becomes the property of the White Mountain Apache Tribe, Division of Human Resources-Personnel Dept. NO FUTURE COPIES MAY BE MADE . Every Question MUST Be Answered.
(If you have submitted an application within one year time frame, it may be used for other job announcements.)
Section A --  Please Note:  Pre-Employment testing may be required                                                                     
 1.POSITION APPLIED FOR:                       DATE:           2.ANNOUNCEMENT NO.
Section B  --  APPLICATION INFORMATION   --   Must have Valid Driver's License on file.
 3.NAME (Last, First, Middle):                                                                  4.SOCIAL SECURITY NUMBER:                            
 5.ADDRESS (P.O. Box number/Street/Apt.No.):           CITY, STATE, ZIP CODE                                                      

 6. COMMUNITY YOU LIVE IN:                               

  7.PHONE NUMBERS (Home, Work)
 8.TRIBAL AFFILIATION                                                 
 9.. HAVE YOU EVER FILED AN APPLICATION WITH THE TRIBE BEFORE?      YES NO    IF YES, GIVE DATES:
 10.HAVE YOU EVER BEEN EMPLOYED WITH THE TRIBE BEFORE?     YES NO    IF YES, GIVE DATES:
 11.ARE YOU CURRENTLY EMPLOYED?   YES NO    IF YES, MAY WE CONTACT YOUR PRESENT EMPLOYER?     YES     NO
 12. TYPE OF EMPLOYMENT DESIRED:   FULL-TIME    PARTTIME    TEMPORARY   ON-CALL   SEASONAL
 13. SHIFTS YOU'RE ABLE AND WILLING TO WORK:     DAY SHIFT    EVENING SHIFT    NIGHT SHIFT    ROTATING 
 14. WILL YOU ACCEPT A JOB THAT REQUIRES YOU TO WORK ON WEEKENDS OR HOLIDAYS?    YES   NO
 15. WILL YOU TRAVEL, IF REQUIRED?   YES   NO
16. IF REQUIRED, WILL YOU UNDERGO A PRE-EMPLOYMENT PHYSICAL?    YES  NO
 17. WILL YOU WORK OVERTIME, IF REQUIRED?     YES   NO
 18. DRIVER'S LICENSE NO. (If required for ):                                                           STATE:                     
19. HAVE YOU BEEN CONVICTED OF A FELONY IN THE LAST SEVEN (7) YEARS? (Such conviction may be relevant, if work related, but does not bar you from employment.)      YES    NO    IF YES, PLEASE EXPLAIN BELOW THE NATURE OF THE OFFENSE, DATE AND LOCATION:
 

 20. IF LIFTING IS REQUIRED , INDICATE THE AMOUNT OF WEIGHT YOU ARE WILLING & ABLE TO LIFT:  up to 25 lbs   25-50lbs   more than 50 lbs

 21.ARE YOU A U.S. CITIZEN?    YES   NO    IF NO, ARE YOU ELIGABLE TO BE EMPLOYED UNDER A VISA OR ENTRY PERMIT?   YES   NO 
 22.INDICATE ANY LANGUAGES YOU SPEAK, READ AND WRITE FLUENTLY 

SECTION C -- EDUCATION AND TRAINING (LIST MOST RECENT FIRST) 
           FLUENT   GOOD    FAIR
   SPEAK                    
   READ                      
WRITE                                  
  

SCHOOL NAME

CITY/STATE

DATES ATTENDED

HIGHEST GRADE COMPLETED

DEGREE/DIPLOMA DATE RECEIVED

                                                                      
                                                                                                 
                                                                         
  		 
    High School Diploma or GED copy to be attached.  --  Applications must have three reference letters attached from recent employers.

SECTION D -- WORK HISTORY  (LIST MOST RECENT JOB FIRST AND WORK BACKWARDS)      Page 2
FROM MO./YR.                                        TO:  
JOB TITLE:                                                                                                                
TYPE OF BUSINESS                                                                  HRS Per WEEK                      

STARTING SALARY                   Per    

FINAL SALARY                 Per     
                     
EMPLOYER'S NAME 
NO EMPLOYEES SUPERVISED
COMPLETE ADDRESS                                                         
SUPERVISOR'S NAME                    CITY, STATE, ZIP CODE                
PHONE NUMBER          
SUPERVISOR'S TITLE
REASON FOR LEAVING:                           
A DESCRIPTION OF DUTIES AND RESPONSIBILITIES
  
   
FROM MO./YR.                                        TO:  
JOB TITLE:                                                                                                                
TYPE OF BUSINESS                                                                  HRS Per WEEK                      

STARTING SALARY                   Per    

FINAL SALARY                 Per      
                     
EMPLOYER'S NAME 
NO EMPLOYEES SUPERVISED
COMPLETE ADDRESS                                                         
SUPERVISOR'S NAME                    CITY, STATE, ZIP CODE                
PHONE NUMBER          
SUPERVISOR'S TITLE
REASON FOR LEAVING:                           
A DESCRIPTION OF DUTIES AND RESPONSIBILITIES
   
   
FROM MO./YR.                                        TO:  
JOB TITLE:                                                                                                                
TYPE OF BUSINESS                                                                  HRS Per WEEK                      

STARTING SALARY                   Per     

FINAL SALARY                 Per      
                     
EMPLOYER'S NAME 
NO EMPLOYEES SUPERVISED
COMPLETE ADDRESS                                                         
SUPERVISOR'S NAME                    CITY, STATE, ZIP CODE                 
PHONE NUMBER          
SUPERVISOR'S TITLE
REASON FOR LEAVING:                           
A DESCRIPTION OF DUTIES AND RESPONSIBILITIES
   
    

Section E -- ADDITIONAL INFORMATION   Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with the Tribe.______________________________________________________________
_____________________________________________________________________________________________________________

List any additional informatin you would like the Tribe to consider :___________________________________________________________________________
________________________________________________________________________________________________________________________________________
Section D --   STATEMENT OF CERTIFICATION - APPLICANT SIGNATURE:  
By signing this application, I certify under penalty of law that the information provided anywhere in this application is true, correct, and complete to the best of my knowledge and belief.  I also acknowledge that, should investigation at any time disclose any misrepresentation, my application may be rejected.  My name may be removed from further consideration, and I may be disqualified from further examinations and/or terminated from employment.  I also authorize the White Mountain Apache Tribe, Division of Human Resources, Personnel Department, to make all necessary and appropriate investigations allowable by law to verify the information provided:

Signature of Applicant:_______________________________________________ Date:____________________