Employment Application Please enable JavaScript in your browser to complete this form.Position Applying For: *Name *FirstLastAddressAddress, City, State and ZIPPhone Number *Email *EmailConfirm EmailSocial Security Number *Gender *MaleFemaleMarital Status *SingleMarriedDivorcedTribal Affiliation:Census Number:Spouse of a Tribal Member? *YesNoName of SpouseEmergency Contact Name: *Employment Verification *I acknowledge and authorizeBy checking the above box, I hereby authorize the Jicarilla Apache Nation to seek employment information and authorize employers listed below to release any information about me that may be sought in connection with the submission of this employment application.1 - Company Name1 - Supervisor Name1 - Company LocationAddress, City, State and ZIPStarting Work Date (dd/mm/yyyy):Ending Work Date (dd/mm/yyyy):1 - Salary Begin1 - Salary End1 - Position(s) Held1 - Reason for Leaving1 - Description of Work2 - Company Name2 - Supervisor Name2 - Company LocationAddress, City, State and ZIPStarting Work Date (dd/mm/yyyy):Ending Work Date (dd/mm/yyyy):2 - Salary Begin2 - Salary End2 - Position(s) Held2 - Reason for Leaving2 - Description of Work3 - Company Name 3 - Supervisor Name3 - Company LocationAddress, City, State and ZIPStarting Work Date (dd/mm/yyyy):Ending Work Date (dd/mm/yyyy):3 - Salary Begin3 - Salary End3 - Position(s) Held3 - Reason for Leaving3 - Description of Work High School/GED School Name and Location (if none, please state N/A) (copy) *High School Diploma/GED Received? *YesNoCollege/University School Name and Location (if none, please state N/A)College/University Date(s) AttendedCollege/University Diploma or Degree ReceivedAssociate's DegreeBachelor's DegreeMaster's DegreePhDNoneOther/Additional/Vocational School Name and Location (if none, please state N/A) (copy)Other/Additional/Vocational Date(s) Attended Other/Additional/Vocational Diploma or Degree Received List any certifications or licenses that would be relevant to the position you are applying for:List any specific skills you possess (i.e. typing, crafts, equipment, machinery, etc.) that may be relevant to the position you are applying for:Have you ever been convicted of a misdemeanor? *YesNoHave you ever been convicted of a felony? *YesNoHave you ever been convicted of any type of theft or fraud? *YesNoState the crime for which you were convicted, dates of conviction and the location (city, state) of the court in which you were convicted. You may also provide any relevant details.Have you ever been ARRESTED or CONVICTED of a crime involving violence, sexual assault, sexual molestation, sexual exploitation, sexual contact, prostitution, or any crimes against persons? *YesNoPlease describe the disposition (final outcome) of the arrest or charge:Criminal Record and Background Check *I acknowledge and understandBy checking the above box, I hereby acknowledge and understand that there 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. 101-360.Reference #1 *Name, phone, relationship (i.e. former supervisor, friend, co-worker, etc.)Reference #2 *Name, phone, relationship (i.e. former supervisor, friend, co-worker, etc.)Reference #3 *Name, phone, relationship (i.e. former supervisor, friend, co-worker, etc.)Reference Verification *I authorizeBy checking the above box, I hereby authorize the Jicarilla Apache Nation to seek information, and request each reference to release any information about me that may be sought in connection with the submission of this employment application.SIGNATURE *By typing my name above, I certify that all statements on this application are true and that any falsifications or willful omission shall be sufficient cause for refusal or dismissal of employment.NameSubmit Application
