menominee indian tribe of wisconsin human resources department

MENOMINEE INDIAN TRIBE OF WISCONSIN P.O. Box 910 Keshena, WI 54135-0910 Phone: (715) 799-5145   Fax: (715) 799-1364 Job Hotline: (715) 799-4111 Apply Online: WWW.MENOMINEE-NSN.GOV APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer

The Menominee Tribe does not discriminate on the basis of race, color, religion, sex and age, national origin or handicap. However, persons of Indian Ancestry will be given preference by law.

Date of Application:

Position Applied For: None - Reference Only Correctional Officer - Male Education/Disabilities Manager Housekeeper/Maintenance Housing Inspector JustWare Coordinator Maintenance Worker Patrolman - Eligibility List Special Education Paraprofessional Subsitute Teacher

Name: Social Security Number: (If applicable) --   Last First Middle Drivers License No.: (If applicable)

Mailing Address: -   Street/P.O. Box City State Zip

Telephone Number: () - Secondary Telephone Number: () -   (Area Code) Number   (Area Code) Number Email Address:

REFERENCES Names, addresses and phone numbers of three persons; two professional & one personal who you have known 5 years. No previous employers. Name Title or Position Address Phone Number () - () - () -

Please summarize Special Skills, Qualifications, Training and/or Certifications acquired from employment or other experiences.

EDUCATION Select Highest Education Completed:   Grade School High School College   1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4

Name/Location Area of Study/Courses Studied Did you Graduate? High School Yes  No HSED  GED College Yes  No Graduate School, Apprentice, Business or Vocational School Yes  No

EMPLOYMENT EXPERIENCE Start with your present or last job. Include military service assignments and volunteer activities. You may exclude organization names, which will indicate race, color, religion, gender, national origin, handicap or other protected status. Employer #1 Name: Start Date Month/Year: Address:   End Date: Month/Year: City   Salary: Start:    End: State:     Zip: Phone: () - Job Title:   Supervisor: Job Duties:   Reason Left: Employer #2 Name: Start Date Month/Year: Address:   End Date: Month/Year: City   Salary: Start:    End: State:     Zip: Phone: () - Job Title:   Supervisor: Job Duties:   Reason Left: Employer #3 Name: Start Date Month/Year: Address:   End Date: Month/Year: City   Salary: Start:    End: State:     Zip: Phone: () - Job Title:   Supervisor: Job Duties:   Reason Left: Employer #4 Name: Start Date Month/Year: Address:   End Date: Month/Year: City   Salary: Start:    End: State:     Zip: Phone: () - Job Title:   Supervisor: Job Duties:   Reason Left: Have you ever been convicted of a felony within the last 7 years? Yes No (Conviction will not necessarily disqualify applicant from employment.) If yes, please explain: Veteran (Honorable Discharge)? Yes No Are you an enrolled Menominee? Yes No If Yes, Enrollment Number: Are you employed now? Yes No May we contact your present employer? Yes No List professional, trade business or civic activities and offices held. (You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status.): Application Statement I certify that 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. The applicant understands that neither this document nor any offer of employment from the employer constitutes an employment contract unless the employer and employee in writing execute a specific document to that effect. 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, also, that I am required to abide by all the rules and regulations of the employer. I understand, also, that if I am hired, that I will be subject to drug testing procedures and any other rules and regulations enforced by the employer. Signature of Applicant Date

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