NVN Employment Application:

Native Village of Napaimute Application for Employment

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POSITION APPLIED FOR____________________________________________________(One Position per application)

 

All employment with the Native Village of Napaimute (NVN) is considered “at will” employment. NVN reserves the right to terminate any “at will” employee at any time with or without cause. Likewise, any employee is free to terminate his/her employment with NVN at any time, with or without reason.

 

 

 

NAME____________________________________________________________________________________________________

LAST                                                                       FIRST                                                      MIDDLE

 

ADDRESS_________________________________________________________________________________________________

BOX NUMBER                                                        CITY                                       STATE                               ZIP CODE

 

TELEPHONE NUMBER ( _______ ) ________-__________SOCIAL SECURITY NUMBER______________________________

AREA CODE

Do you claim American Indian/Alaska Native Preference? __________   If yes, you will need to provide documentation if hired

 

 
 

May we contact you at work?………………………………………………………………………………………..       YES         NO

 

If yes, work number and best time to call……………………………………….(______) _____________________   ____________

Area Code                                                         Time

 
 

 

 

Have you filed an application here before?………………………………………………………………………….        YES       NO

 

If yes, give date…………………………………………………………………………………………………..…_____/_____/_____

 

 
 

Have you ever been employed here before?……………………………………………………………………….           YES         NO

 

If yes, give dates………………………………………………………………….FROM _____/_____/_____ TO _____/_____/_____

 
 

 

 

Are you legally eligible for employment in this country?…………………………………………………………..           YES       NO

(Proof of U.S. citizenship or immigration status will be required upon employment.)

 

Date available to work…………………………………………………………………………………………..…_____/_____/_____

 
 
 
 
 

 

 

Type of employment desired:         Full Time           Part-Time           Temporary           Seasonal             Educational Co-Op

 

 
 

Are you on a lay-off and subject to recall?…………………………………………………………………………           YES         NO

 

 
 
 
 

Will you relocate if job requires it?…..       YES         NO………….Will you travel if job requires it?………….         YES         NO

 

 
 

Will you work overtime if required?………………………………………………………………………………..             YES         NO

 

 
 

If required by the employer, will you undergo pre-employment physical?…………………………………………       YES         NO

 

 
 

Can you perform the essential functions of this job with or without reasonable accommodations?………………………       YES         NO

(If you have not reviewed a copy of the job description, please ask to do so before answering this question)

 

 
 

Have you ever been convicted of a felony?…………………………………………………………………………………..       YES         NO

 

If Yes, please explain: _______________________________________________________________________________________

 

(Conviction of a crime will not necessarily bar you from employment)

 

Driver’s License Number (If required by Job)………………………………._______________ State__________

 

 

THE Native Village of Napaimute IS AN EQUAL OPPORTUNITY EMPLOYER

 

Educational Background

 

  1. List last three (3) schools attended, starting with last one. B. List number of years completed, C. Indicate degree or diploma earned, if any, D. Grade Point Average or Class Rank and E. Major and minor field of study (if applicable).
A. SCHOOL B. NO. YEARS         COMPLETED
  1. DEGREE

       DIPLOMA

  1. GPA

CLASS RANK

E.

       MAJOR

E.

     MINOR

           
           
           

 

List any foreign language(s) and check the box that best describes your skill level:

 

LANGUAGE READ AND WRITE READ AND SPEAK READ ONLY SPEAK ONLY
         
         
         
         

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

 

NAME TELEPHONE NUMBER YEARS KNOWN
  (       )             –  
  (       )             –  
  (       )             –  

 

List professional, trade, business or civic associations and any offices held. (Exclude memberships, which would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

 

ORGANIZATION

OFFICES HELD
   
   
   

 

 

List special accomplishments, publications, and awards. (Exclude information, which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status.) ___________________________________________________________

 

__________________________________________________________________________________________________________

 

 

List any additional information you would like us to consider: ________________________________________________________

 

 

 

 

 

 

 

 

 

 

Employment History

 

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.

 

Employer                                                       Telephone Number

(     )             –

Dates Employed Summarize the nature of the work performed and job responsibilities:
From To  
Address      
Job Title

 

Hourly Rate  
Starting
Immediate Supervisor and Title

 

$ PER  
Reason For Leaving

 

Hourly Rate  
Final
 
 
 

May we contact for reference?       YES         NO         LATER

$ PER  

 

Employer                                                       Telephone Number

(     )             –

Dates Employed Summarize the nature of the work performed and job responsibilities:
From To  
Address      
Job Title

 

Hourly Rate  
Starting
Immediate Supervisor and Title

 

$ PER  
Reason For Leaving

 

Hourly Rate  
Final
 
 
 

May we contact for reference?       YES         NO         LATER

$ PER  

 

Employer                                                       Telephone Number

(     )             –

Dates Employed Summarize the nature of the work performed and job responsibilities:
From To  
Address      
Job Title

 

Hourly Rate  
Starting
Immediate Supervisor and Title

 

$ PER  
Reason For Leaving

 

Hourly Rate  
Final
 
 
 

May we contact for reference?       YES         NO          LATER

$ PER  

 

Employer                                                       Telephone Number

(     )             –

Dates Employed Summarize the nature of the work performed and job responsibilities:
From To  
Address      
Job Title

 

Hourly Rate  
Starting
Immediate Supervisor and Title

 

$ PER  
Reason For Leaving

 

Hourly Rate  
Final
 
 
 

May we contact for reference?       YES         NO         LATER

$ PER  

Comments (including explanation of any gaps in employment)

 

 

SKILLS AND QUALIFICATIONS Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our Company.__________________________________________________________________

 

 

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

 

I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

 

The Employer is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state or federal law.

 

This application is current for only sixty (60) days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.

 

 

Signature of Applicant _________________________________________________________________ Date _____/_____/_____

 

The applicant is advised that this application is not a contract of employment. Where applicable, in accordance with federal laws, the Employer gives preference in hiring to applicants who identify themselves as Alaska Natives or American Indians.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANY CHANGES ON THIS APPLICATION WILL MAKE IT NULL AND VOID

 

 

For Personnel Department Use Only

 

 
 

 

 

Position applied for………………………………………………………………………………….…     Available         Not Available

 

Other positions considered for_________________________________________________________________________________

__________________________________________________________________________________________________________

 
 

 

 

Hired…………………       Yes       No                                                                                                             Date of Hire _____/_____/_____

 

Position hired for____________________________________________________________________________________________

 

EEO Classification__________________________________________________________________________________________

 

  1. Officials and Managers                      4.             Sales                                                       7.             Operatives (semi-skilled)
  2. Professionals                                        5.             Office and Clerical                              8.            Laborers (unskilled)
  3. Technicians                                          6.             Craft Workers (skilled)                       9.             Service Workers

 

 

 

Notes___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

 

 

Completed By__________________________________________________________________________Date_____/_____/_____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Voluntary Affirmative Action Information

(Completion of Information Below is Voluntary)

 

 

 

We consider applications for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or disability, or any other legally protected status.

 

Date _____/_____/_____

 

Position Applied For_______________________________________________________________________________________

 

 

 
 
 
 

REFERRAL SOURCE     ADVERTISEMENT     EMPLOYEE       RELATIVE       GOVERNMENT EMPLOYMENT AGENCY

 
 
 

WALK-IN         PRIVATE EMPLOYMENT AGENCY         OTHER

NAME OF SOURCE (IF APPLICABLE)_____________________________________________________

 

 

Applicant’s Name___________________________________________________________________________________________

Last                                         First                                         Middle                                                     Telephone Number

 

Address___________________________________________________________________________________________________

Street/PO Box                                                          City                                          State                                         Zip Code

 

As required, we comply with government regulations including Affirmative Action obligations where they apply.

 

In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations, we ask that you complete this applicant data survey. Your cooperation is appreciated.

 

Please be advised that your survey is not a part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.

 

 
 

Check One…………………………………….         Male           Female

 

Check one of the following race/ethnic group

 
 
 
 
 

 

 

Hispanic             Black           White         American Indian/Alaska Native         Asian/Pacific Islander

 

Check if any of the following are applicable

 

 

 

Vietnam Era Veteran -A Veteran whose military services occurred between August 5, 1964 and May 7, 1975; and,

  1. served on active duty for a period of more than 180 days and was discharged with other than2.   was discharged or released from active duty because of a service connected disability.
     

    Disabled Veteran

     

    Disabled Individual

  2. dishonorable discharge, or

TO BE COMPLETED BY APPLICANT – NOT FOR INTERVIEW PURPOSES – TO BE FILED SEPARATELY FROM APPLICATION

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