Employment Application – American Indian Family Center

An Equal Opportunity Employer

The American Indian Family Center is an Equal Opportunity Employer. We consider all applicants for positions without regard to race, color, creed, religion, national origin, gender, age, sexual orientation, marital status, status as to public assistance, disability, veteran status, or any other legally protected status.

General Information

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Cellular Phone

Other Phone

Position

Desired Position

Date Available for Work

Salary Expected(Required)

If hired, can you provide verification of your legal right to work in the United States?

Yes
No

Referral Source

College (name)
Walk-in
AIFC Facebook
AIFC Website
Newspaper (name)
Employee Referral (list their name)
Other (list source)

College, Newspaper, Employee or Other

Education & Training

Education List(Required)

Please include high school, tech/business school, college, graduate school and/or other schools.

Type	Name	City & State	Area of Study	Did you graduate?

Licenses & Skills

List licenses, computer, equipment, or other skills and training you have:

Proficient Languages (ability to interpret, read, write, speak, and sign):

Employment History

Begin with the most recent employer. Complete entirely even with a resume attached.

Employment History List(Required)

Employer	Supervisor	Phone	Address	Job Title	Ending Salary	Dates	Reason for Leaving	Duties	May we contact?

Resume(Required)

Max. file size: 128 MB.

Activities

List any volunteer, outside, professional, business or civic activities and offices held. (Feel free to exclude groups, which indicate race, color, creed, religion, sex, national origin, age, sexual orientation, marital status, disability, veteran status or other legally protected status.)

Activities List

References

List 3 former supervisors, managers, or co-workers who have knowledge of your skills and qualifications.

References List(Required)

Name	Relationship	Company	Phone

Applicant Acknowledgement

Please read this carefully before signing:

I understand that the American Indian Family Center requires certain information about me to evaluate my qualifications for employment and to conduct its business if I become an employee. Therefore, I authorize the investigation of my past employment, educational credentials and other employment-related activities. I agree to cooperate in such investigations and release those parties supplying such information to the American Indian Family Center from all liability or responsibility with respect to information supplied.

I agree that the American Indian Family Center may use the information it obtains concerning me in the conduct of its business. I understand that such use may include disclosure outside the American Indian Family Center in those cases where its agents and contractors need such information to perform their functions where their company's legal interests and/or obligations are involved, or where there is a medical emergency involving me. I agree that all equipment, notebooks, documents, files, books and other materials which I may prepare, use or possess during the course of my employment are American Indian Family Center property and may not be taken with me or used after I leave.

I UNDERSTAND THAT NOTHING CONTAINED IN THIS EMPLOYMENT APPLICATION OR IN THE GRANTING OF AN INTERVIEW, AND NO COMPANY POLICIES, PROCEDURES, OR HANDBOOKS THAT I MIGHT RECEIVE, ARE INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN THE COMPANY AND MYSELF FOR EITHER EMPLOYMENT OR FOR THE PROVIDING OF ANY BENEFIT. I UNDERSTAND THAT ANY EMPLOYMENT WOULD NOT BE FOR ANY FIXED PERIOD OF TIME AND THAT, IF EMPLOYED, I MAY RESIGN AT ANY TIME WITH OR WITHOUT CAUSE OR THE AMERICAN INDIAN FAMILY CENTER MAY TERMINATE MY EMPLOYMENT AT ANY TIME WITH OR WITHOUT CAUSE. ANY MODIFICATION OF THIS AT-WILL EMPLOYMENT RELATIONSHIP MUST BE PURSUANT TO A WRITTEN CONTRACT SIGNED BY THE PRESIDENT.

I understand that any false answers or statements made by me on this application or any supplement thereto or in connection with the above-mentioned investigation will be sufficient grounds for immediate discharge if I am employed.

Should the position require, my signature below acknowledges my agreement to reference checking or to taking any physical examinations that the American Indian Family Center may require, including testing for illegal or unauthorized substances. I understand that any offer of employment is contingent upon successfully passing the examination requirements and agreeing to take future checks or exams, including drug screening, which the American Indian Family Center may require for the health and safety of its employees and property.

Signature(Required)

Date