ONLINE EMPLOYMENT APPLICATION

Applicant Name ~ Last Name                                   First                                   M.I
 

Date:

 
Mailing Address:   Home Phone:
(      )
City, State & Zip Code:   Message Phone:
(      )
Position Desired: Social Security Number:
 
 

YES:

NO:
Apart from absence for religious observance, are you available for full time work?    
Are you willing to accept and travel for job related training?    
Do you have a Current Valid Alaska Drivers License? Do you have a private vehicle available for job related travel?    

EDUCATION

NAME AND LOCATION OF SCHOOL

COURSE OF STUDY

NO. OF YEARS COMPLETED

DID YOU GRADUATE? WHAT DEGREE:
         
         
         

 

YES

NO

WORDS PER MINUTE
KEYBOARDING      
PBX      
COMPUTER ~ WORD PERFECT      
COMPUTER ~ EXCEL      
COMPUTER ~ PRINT SHOP      
COMPUTER ~ OUTLOOK EXPRESS      
COMPUTER ~ OTHER      
OTHER      

EMPLOYMENT HISTORY

Please give accurate, complete full - time and part-time Employment History. Start with most recent employer.

Copper River Native Association (CRNA) may contact the employers listed below unless you indicate those you do not want Copper River Native Association to contact.

DO NOT CONTACT

Employer (s) and Reason:

Company Name: Telephone:
(      )
Address: Employed (State Month and Year) From:                 To:
 Name of Supervisor: Weekly Pay
Start:                  Last:
 State Job Title and Describe Your Work:  Reason for Leaving:


 
Company Name: Telephone:
(      )
Address: Employed (State Month and Year) From:                 To:
 Name of Supervisor: Weekly Pay
Start:                  Last:
 State Job Title and Describe Your Work:  Reason for Leaving:


 
Company Name: Telephone:
(      )
Address: Employed (State Month and Year) From:                 To:
 State Job Title and Describe Your Work:  Reason for Leaving:


 
Company Name: Telephone:
(      )
Address: Employed (State Month and Year) From:                 To:
 State Job Title and Describe Your Work:  Reason for Leaving:


 

PLEASE LIST (3) THREE REFERENCES (PROFESSIONAL/PERSONAL):


Company Name:  Contact Person and Title:  
Address: Telephone:
(      )
City/State/Zip Code: Relationship to you if any:
 
Company Name: Contact Person and Title:
 
Address: Telephone:
(      )
City/State/Zip Code: Relationship to you if any:
 
Company Name: Contact Person and Title:
 
 City/State/Zip Code: Relationship to you if any:
 

The Bureau of Indian Affairs and Indian Health Services regulations require that Copper River Native Association use “Indian Preference” in employment and training within the programs that the (2) Two agencies fund. If you wish to be considered for “Indian Preference” in employment and training, please complete below.

CORPORATION OR RESERVATION OFFICE:  
ENROLLMENT NUMBER:  
DEGREE AND TRIBE:  
VILLAGE:  
OTHER VERIFICATIONS:  

ALL APPLICANTS WILL BE CONSIDERED REGARDLESS OF SEX, AGE, RELIGION, HANDICAP OR RACE. EXCEPTION FOR “INDIAN PREFERENCE” AS REQUIRED BY THE BUREAU OF INDIAN AFFAIRS AND INDIAN HEALTH SERVICES.

I hereby declare the information provided by this application for employment is true, correct and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause of dismissal. I understand it is my responsibility to notify CRNA if I want this application to be considered for another position. It is my responsibility to up-date this application as needed. All applications will be kept on file with CRNA for (1) one year.

 

                                                                   
SIGNATURE

 

                                            
DATE

 

FOR COPPER RIVER NATIVE ASSOCIATION OFFICIAL USE ONLY:

 

DATE RECEIVED:  POSITION (S) APPLIED FOR:  COMMENTS: