Tachi Yokut Online Application
 Personal Information    * Required Fields
* How were you referred:
   Available Positions  ( Please Choose One )


 

* Please list times you are available to work
ex. [ 9am to 10pm ]

Mon.
Tues.
Wed.
Thur.
Fri.
Sat.
Sun.

 
* Full Name:
* Address:
* City:
* State:
* Zip:
* Your E-mail:
* Phone:    [ex. 555-555-5555]
* Cell/Other:    [ex. 555-555-5555]
* Tribal Member?
* If YES, Enrollment#
* Or Native American Enrollment#
* Lineal Descendant?
* SRR Resident?
* 18 Years Or Older:
* If NO, can you furnish a work permit?
* Position Desired:
* Date You Can Start:
* Pay desired:
* Applied here before?
* If YES, where and when:
* Worked here before?
* If YES, where and when:
* Friends or Relatives work here?       [do not include spouse]
* If YES, state name, relationship, location:
* Currently employed?
* If YES, may we contact your present employer?
* Have you ever been convicted of a criminal offense, felony or serious misdemeanor?
* If YES, give dates/details:
Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
* Type of employment:


* Currently on lay-off status and subject to recall?
* Can you travel if a job requires it?

* Summarize Your Special Skills or Qualifications:

* Describe any job-related training received in the United States Military:
 
 Education History:
 High School  Location  Years Completed  Diploma/Degree
 College  Location  Years Completed  Diploma/Degree
 Graduate School  Location  Years Completed  Diploma/Degree
 Business/Trade/Technical School  Location  Years Completed  Diploma/Degree
 
 Previous Employment: ( begin with most recent position )
Dates of Employment: From:   To:    [MM/YYYY]
Positions(s) Held:
Firm / Company: 
Address of Employer:    [Street, City, State, and ZIP code]
Phone Number:    [ex. 555-555-5555]
Supervisor:
Title of Supervisor:
Your Responsibilities:
Starting Salary & Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer for reference? Yes     No
 
 Previous Employment:
Dates of Employment: From:   To:    [MM/YYYY]
Positions(s) Held:
Firm / Company: 
Address of Employer:    [Street, City, State, and ZIP code]
Phone Number:    [ex. 555-555-5555]
Supervisor:
Title of Supervisor:
Your Responsibilities:
Starting Salary & Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer for reference? Yes     No
 
 Previous Employment :
Dates of Employment: From:   To:    [MM/YYYY]
Positions(s) Held:
Firm / Company: 
Address of Employer:    [Street, City, State, and ZIP code]
Phone Number:    [ex. 555-555-5555]
Supervisor:
Title of Supervisor:
Your Responsibilities:
Starting Salary & Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer for reference? Yes     No
 
 Personal/Professional References: ( Do not include family members or past supervisors )
Name Phone Number Best Time To Call Occupation
 


APPLICANT'S STATEMENT

AUTHORIZATION

"I certify that the facts contained in this application are true to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from the utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

 

I agree to the AUTHORIZATION

      


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