Employment Application

Complete and Submit Your

Below is our convenient supplemental information form for your use. Upon completion please submit it and allow our staff to process the information. If there are any questions related to the information you provided, we will follow-up with you via the preferred method of communication you’ve indicated on the form. Thank you.

Employment Application (Supplemental Information Form)

The Phoenix Indian Center, Inc. is an EEOC, Employment-At-Will, and Indian Preference employer along with a Drug-Free and Commercial Smoke-Free work environment. All employment is based upon appropriate clearances.

Title of position(s) applied for *

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

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Email *

EMPLOYMENT HISTORY (start with your present or last job - provide information for your last three positions)

Employer Name *

Your Position *

Are you currently working for this employer?

Start Date *

End Date

Reason for leaving

Employer 2 Name

Your Position *

Start Date *

End Date *

Reason for leaving *

Employer 3 Name

Your Position *

Start Date *

End Date *

Reason for leaving *

Please upload a copy of your resume *

Click or drag a file to this area to upload.

Please upload a copy of your cover letter *

Click or drag a file to this area to upload.

Educational Record

High School Name *

School Address

Address Line 1

City

State

Zip Code

Start Year *

End Year *

Did you graduate and receive your High School Diploma or High School Equivalency Diploma? *

Undergrad College Name

Course of Study

School Address

Address Line 1

City

State

Zip Code

Start Year *

End Year *

Did you receive an Undergraduate Degree? *

Degree Name *

Undergrad College Name (2)

Course of Study

School Address

Address Line 1

City

State

Zip Code

Start Year

End Year

Did you receive an Undergraduate Degree? *

Degree Name *

Graduate/Professional College Name

Course of Study

School Address

Address Line 1

City

State

Zip Code

Start Year

End Year

Did you receive a Graduate Degree? *

Degree Name *

Other (Specify)

Course of Study

School Address

Address Line 1

City

State

Zip Code

Start Year *

End Year

Did you receive a Degree or Certificate? *

Degree/Certificate Name

SPECIAL SKILLS/QUALIFICATIONS (list all honors/professional membership/certification/license etc.)

Are you a Veteran of the United States military service?

What branch?

Date of entry

Date of discharge

Are you claiming American Indian preference? *

Tribal affiliation *

Please upload proof of tribal enrollment. Documentation must be included in order to claim preference *

Click or drag a file to this area to upload.

Are you related to anyone in our agency? *

Please list name and relationship *

Language Information

Other than English, do you understand any language(s)? *

Yes
Partially
No

Please list the other language(s) you understand other than English.

Other than English, do you speak any language(s)? *

Yes
Partially
No

Please list the other language(s) you speak other than English. *

Other than English, do you read/write any language(s)? *

Yes
Partially
No

Please list the other language(s) you read/write other than English. *

Background

Do you have or can you successfully apply for/receive a fingerprint clearance card? *

Have you been convicted of a crime? *

Please provide the date(s) and fully explain the circumstances. (Note: a conviction may not necessarily disqualify an applicant from employment) *

ADDITIONAL INFORMATION: State information you feel may be helpful to us in considering your application, i.e. professional certifications, skills relevant to position you are applying for.

By typing my name here, I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge I understand that I am required to abide by all rules and regulations of the Phoenix Indian Center, Incorporated. *

First

Last

Date of Completion *

Employment Application

EMPLOYMENT HISTORY (start with your present or last job - provide information for your last three positions)

Educational Record

Language Information

Background

WE ARE AN EQUAL OPPORTUNITY EMPLOYER - AMERICAN INDIAN PREFERENCE