application for employment

United Tribes Technical College provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, or status as a Vietnam-era or special disabled veteran in accordance with applicable federal laws, except where specific age, sex or physical requirements are a bona fide occupational qualification, or where Indian Preference or Veteran's Preference are appropriately claimed.

Persons of Indian ancestry who are at least 1/4 degree and wish to claim Indian Preference must submit a statement indicating the degree of Indian blood and agency enrollment.

- We are an equal opportunity employer -

Position(s) Applied For:
Date: Tuesday, June 29, 2010 2:57 PM

Name:

Social Security Number:

Street: Apt. No.

City: State: Zip:

Phone Number:

E-Mail Address:

Do you want to work: Full Time Part Time
If part time, specify days and hours:

Are you willing to work overtime as necessary?

Date you can start:
Salary desired: $ per

Have you ever been employed by us?

If yes, when?

Is there anything that would prevent you from performing in a reasonable and safe manner the activities involved in the position for which you have applied?

If yes, please explain:

Have you ever been convicted of a crime?*

If yes, state nature of offense, when, where, and disposition:

Do you have the legal right to work and remain in the United States?**

* A conviction record will not necessarily be a bar to employment. This information will be used only for job-related purposes and only to the extent permitted by applicable law.
** Federal laws require that employees hire only individuals who are authorized to be lawfully employed in the United States. In compliance with such laws, UTTC will verify status of every individual offered employment with UTTC. In this connection, all offers of employment are subject to verification of the applicant identity and employment authorization, and will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization upon employment.
State name(s) of any relative(s) in our employment and your relationship to them:
Indicate what foreign language and/or Indian languages or dialects you speak, read, and/or write:

Record of Education

School
Address of School, City, State
Courses of Study
Number of Years Completed Did You Graduate?

Diploma or Degree Received

School
Address of School, City, State
Courses of Study
Number of Years Completed Did You Graduate? No
Diploma or Degree Received

School
Address of School, City, State
Courses of Study
Number of Years Completed Did You Graduate? Yes No
Diploma or Degree Received

Prior Work History

(List in order, last or current employer first. Account for any gaps in your employment.)

Employer Name
Position Title
Employer Address, City, State
Telephone Number of Employer
Dates Employed
Supervisor's Name/Title
Rate of Pay
Reason for Leaving
Describe in detail the work you performed

Employer Name
Position Title
Employer Address, City, State
Telephone Number of Employer
Dates Employed
Supervisor's Name/Title
Rate of Pay
Reason for Leaving
Describe in detail the work you performed

Employer Name
Position Title
Employer Address, City, State
Telephone Number of Employer
Dates Employed
Supervisor's Name/Title
Rate of Pay
Reason for Leaving
Describe in detail the work you performed

Comments: (Include explanation of any gaps in employment.)

Military Service Record

Have you ever served in the United States Armed Forces?

List duties in the Service, including special training that is relevant to the position for which you are applying for.

Skills

Summarize job-related skills and qualifications or certifications:
Typing: w.p.m  
Computer Programs:
Other Office Equipment:
Are there any other experiences, skills, or abilities you feel may be helpful to us in considering your application?

Personal References

(Excluding relatives) List two work-related references and one personal reference

Name
Address
Telephone
Occupation
Dates Known

Name
Address
Telephone
Occupation
Dates Known

Name
Address
Telephone
Occupation
Dates Known

Pre-Employment Statement

(Please read carefully and sign the statement below.)

I understand that:

  1. The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from UTTC's employment.

  2. I understand that any offer of employment that I receive from UTTC is contingent upon my successful completion of the college's total pre-employment screening process, including UTTC receiving references that it considers satisfactory.

  3. If UTTC decides to engage an investigative consumer reporting agency to report on my education or personal history, I authorize it to do so. I understand that it will do so if it has a business-related reason for doing so. If a report is obtained, I understand that upon written request, the name of agency will be provided to me so that I may obtain information regarding the nature and substance of information contained in the report.

  4. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of UTTC and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either UTTC or myself. I further understand that no manager or representative of UTTC, other than the President has the authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and by the individual designated above.

Signature: Date:
My electronic signature indicates that I have read, understand, and accept all terms contained in my application. It also states that all information I submit is my own and factually correct.

 

Applicant Data Record

Referral Source:
  Radio Announcement Other:

Government agencies require periodic reports on the sex, ethnicity, handicapped and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a handicap is voluntary.

Check one:


Check one of the following:
Race/Ethic Group:

Black

Check if any of the following are applicable:

Employment Inquiry Release

In connection with my employment with you, I understand that investigative background inquiries are to be made on myself. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences, as well as claims involving me in the files of insurance companies and worker's compensation claims.

I authorize, without reservation, any party or agency contacted by this employer or this employer's representative to furnish the aforementioned information.

Name:
SSN: DOB:
DL#-State:  
Address:
City: State: Zip: County:
Previous Address:
City: State: Zip: County:
Employment Start Date:
Other important information: (List additional places of residency include reservation, any convictions-state and/or tribal,etc.)
Tribal Affiliation: (Agency and Enrollment # if available)
Signature: Date:
My electronic signature indicates that I have read, understand, and accept all terms contained in my application. It also states that all information I submit is my own and factually correct.

 

 


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United Tribes Technical College
3315 University Dr.
Bismarck, ND 58504
Ph: (701)255-3285 x.1285
Fax: (701) 530-0629