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PLEASE READ CAREFULLY
Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.
Attach Resume:
*Email:
Applying for:

Applicant Information

*First Name:
*Last Name:
MI:
*Address:
Apartment/Unit #
*City
*State
*Zip
*Phone:
Referred By:
Date Available:
Salary Expected:
Apart from absence for religious observance, are you available for full-time work?:
   Yes    No
Will you work overtime if asked?:
   Yes    No
U.S. Citizen:
   Yes    No
If not, are you authorized to work in the U.S.?:
 Yes     No
*Have you ever worked for this company?:
 Yes   
 No
If yes, when?:
------ To ------
*Have you ever been convicted of a felony?
(By company policy some misdemeanors may bar employment):
 Yes   
 No
If yes, explain briefly:
Other special training or skills (languages, machine operation etc.)


Education

High School:
Address:
Graduate:
Yes No
Degree:
College:
Address:
Graduate:
Yes No
Degree:
Other:
Address:
Graduate:
Yes No
Degree:

References

Please list three references not related to you, whom you have known at least one year.
Name:
Occupation:
Company:
Day Phone Numbers:
Address:
Name:
Occupation:
Company:
Day Phone Numbers:
Address:
Name:
Occupation:
Company:
Day Phone Numbers:
Address:

Employment History

Company Name:
Complete Address
(w/ City, State, Zip):
Phone:
Supervisor:
Job Title:
Responsibilities:
Starting Salary:
Ending Salary:
Start Date:
(mm/dd/yyyy)
 
End Date:
(mm/dd/yyyy)
 
Reason for Leaving:
May we contact your previous employer for a reference?
 Yes    No



DRIVING RECORD

Do you have a valid Driver's License?
Yes No
Issuing State
Driver's License Number
Expiration Date
Any restrictions on your license?
Yes No
If "Yes", please explain:

Military Service

Start Date:
(mm/dd/yyyy)
End Date:
(mm/dd/yyyy)
Branch:
For veteran preference, please upload DD214:

INDIAN PREFERENCE

The Alabama-Coushatta Tribe has chosen to extend preference to enrolled members of the Tribe and to enrolled members of other federally-recognized Indian tribes in all aspects of employment
Are you a member of a federally recognized Tribe?
Yes No
If "Yes", please list name of Tribe
Are you claiming Indian Preference?
Yes No
If "Yes", please send FORM BIA 4432

Applicant's Statement

Notification and Agreement

Please read and understand this statement before signing your application The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment.

I authorize the employer to contact and obtain information about me from previous employers, educational institutes and “references” I provided, and any other party necessary to verify the accuracy of information I disclosed in this application, a related employment resume or a personal interview. To assist in the processing of my Application, I waive all rights and claims I may have otherwise have against my employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide the information for this purpose.

This application will expire in 30 days. After the date, unless otherwise notified, I understand my status of an applicant will end. I may re-apply for employment in the future by completing a new application.

This application is not an employment agreement. If I accept an offer of employment, I understand the employer may terminate my employment at any time, with or without cause and without prior notice, unless required by law. I understand that no one, other than an executive officer of the employer, has authority to enter into any employment agreement with terms contrary to the foregoing and then only in writing signed by such officer.

Signature below verifies you have read the above notice and understand what it means.




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