Jicarilla Apache Nation Human Resources
Jicarilla Apache Nation Employment Application
Fields marked with an * are required and must be completed.


Position Applied For * Date of Application *
Referral Source Newspaper
Employee Relative Friend Other
Walk-in Internet Job Announcement Notice
Name * Social Security No . * - -
Address * City * State * Zip Code *
Phone * Cell Email *
In case of an emergency, notify * Name @ * Phone
Tribal Affiliation Tribal Enrollment/Census No.
Proof of Native American heritage must be provided to the Human Resource Department with this application.
Are you the spouse of a Tribal Member? * Yes No      
Name of Spouse:
Have you ever served in the military? * Yes No
Are you a member of the US Reserve or National Guard? * Yes No
From To Type of Discharge
Copy of DD 214 must be provided to the Human Resource Department.

Date you are available for work *  Available to work: * Full-time Part time Temporary

Best time call you at home * . May we contact you at work? * Yes No
If yes, work number and best time to call   Phone  
 

Have you ever been convicted of or pleaded guilty to any law violation (except speeding or parking violation)?

* Yes No        If Yes, give details

Do you have a valid driver's license? * Yes No,    

License No. State

 
Educational Background - All applicants may be required to submit transcripts from their educational institution.
School Name / Location / Phone Course of Study Year Completed Type of Degree
High School / GED
University or College
Graduate / Professional
Vocational / Trade
Employment History
Start with your present or last job and please include any relevant military service assignments and volunteer work.
1. Employer's Name * Job Title * From * To *
Address * Supervisor's Name * Starting Pay * Ending Pay*
City * State * Zip Code * Hours worked per week *
  Phone No. *  
     
Duties *
Reason for Leaving *
2. Employer's Name * Job Title * From * To *
Address * Supervisor's Name * Starting Pay * Ending Pay *
City * State * Zip Code * Hours worked per week *
  Phone No. *  
     
Duties *
Reason for Leaving *
3. Employer's Name Job Title From To
Address Supervisor's Name Starting Pay Ending Pay
City State Zip Code Hours worked per week
  Phone No.  
     
Duties
Reason for Leaving
 
Specialized Skills and Qualifications (Check all that apply)
Microsoft Word Microsoft Publisher Microsoft Imaging
Microsoft Excel Microsoft Access Microsoft Powerpoint
Internet Graphics Office Machines
Summarize any special training, skill, licenses and/or certificates that may qualify you as being able to perform the job functions of the position for which you are applying.
 
References  
List three people that you have known for at least three years who are not related to you and are not supervisors you listed in the Employment History section. They must know your qualifications and fitness for the kind of job you are applying for.
1. Name * Phone No. *
   
Address * Title *
   
2 Name * Phone No. *
   
Address * Title *
   
3 Name * Phone No. *
   
Address * Title *
   
Applicant Statement  

I hereby authorize the Jicarilla Apache Nation to seek and also authorize and request each reference and each former employer named above to release any information that may be sought in connection with the submission of this employment application.

I understand and acknowledge that this application does not create an employment relationship with the Jicarilla Apache Nation.

If applying for a position working with children, I hereby acknowledge and understand that therein will be a criminal record and background check conducted by the Jicarilla Apache Nation according to the rules and regulations of the Indian Child Protection and Family Violence Prevention Act P.L. 101-630.

I certify that all statements herein are true and that any falsifications or willful omission shall be cause for dismissed or refusal of employment.

 

Signature/ Name of Applicant * Date
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