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Kaw Nation Careers

Job Application

COMPLETE APPLICATION BELOW

POSITION YOU ARE APPLYING FOR

Today's Date *

Are you seeking: *Full-TimePart-TimeIntershipOther

If other, input here.0 / 12

When are you available to start? *

Last Name *

Middle Name *

First Name *

Other names you have used in the past:

Street Address *

City/State/Zip *0 / 50

Birth Date *

Social Security Number *0 / 12

Phone *

Email Address

Are you 18 years or older? *YESNO

Do you claim Indian Preference? *YESNO

Tribal Affiliation0 / 100

Please attach Certificate Degree of Indian Blood (CDIB)

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DO YOU HAVE A VALID DRIVER LICENSE? *YESNO

Driver's License Number

Driver's License State

Driver's License Type

Does your driver's license have any restrictions?YESNO

If yes, please explain restrictions:0 / 200

Has your driver's license been suspended or revoked in the last 5 years? *YESNO

List all states that you have lived in, including where you were born: *

Would you be insurable to drive our company vehicles? *YESNO

Have you served in the Military or National Guard? *YESNO

If yes, which branch?

If yes, attach the DD-214 Form

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Have you been convicted of a felony in the past 10 years? *YESNO

Have you EVER been convicted of a crime? Exclude minor traffic violations. *YESNO

Are you a registered sex offender? *YESNO

Would you be willing to submit to an Alcohol & Drug Testing? *YESNO

Would you be willing to submit a release for permission to conduct a background check? *YESNO

Have you ever applied for employment here? *YESNO

Have you ever been employed anywhere within Kaw Nation? *YESNO

If yes, When were you employed?

Where were you employed?

If hired, can you furnish proof you are eligible to work in the U.S.? *YESNO

SKILLS AND QUALIFICATIONS

EDUCATIONAL BACKGROUND

List the schools attended starting with the most recent:

1.) School and Location

Dates Attended

Course of Study

Degree/Certificate

Did you Graduate?YESNO

2.) School and Location

Dates Attended

Course of Study

Degree/Certificate

Did you Graduate?YESNO

3.) School and Location

Dates Attended

Course of Study

Degree/Certificate

Did you Graduate?YESNO

4.) School and Location

Dates Attended

Course of Study

Degree/Certificate

Did you Graduate?YESNO

Do you possess a high school diploma? *YESNO

*If No, do you posse a general education diploma (GED)?YESNO

What is the highest level of education completed?

Have you attended school under any other names? *YESNO

If yes, please list names:

Employment History

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment in the last 10 years. If self-employed, give firm name and supply business references. NOTE: A job offer is contingent upon verification of references and drug screen and background check. (Please do not write “see resume”).

A.) Employer

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

Phone Number

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

Job Title

Supervisor

Ending Salary

USD

May we contact?YESNO

Reason for Leaving

Job Duties

B.) Employer

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

Phone Number

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

Job Title

Supervisor

Ending Salary

USD

May we contact?YESNO

Reason for Leaving

Job Duties

C.) Employer

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

Phone Number

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

Job Title

Supervisor

Ending Salary

USD

May we contact?YESNO

Reason for Leaving

Job Duties

D.) Employer

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

Phone Number

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

Job Title

Supervisor

Ending Salary

USD

May we contact?YESNO

Reason for Leaving

Job Duties

E.) Employer

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

Phone Number

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

Job Title

Supervisor

Ending Salary

USD

May we contact?YESNO

Reason for Leaving

Job Duties

Are you presently employed? *YESNO

If yes, may we contact them for reference?YESNO

If yes, name of contact

REFERENCES

Give at least three (3) individuals NOT related to you but whom you have known at least one year.

REFERENCE #1 *

RELATION *

TITLE *

COMPANY *

Phone *

REFERENCE'S ADDRESS *

REFERENCE #2 *

RELATION *

TITLE *

COMPANY *

Phone *

REFERENCE'S ADDRESS *

REFERENCE #3 *

RELATION *

TITLE *

COMPANY *

Phone *

REFERENCE'S ADDRESS *

REFERENCE #4

RELATION

TITLE

COMPANY

Phone

REFERENCE'S ADDRESS

REFERENCE #5

RELATION

TITLE

COMPANY

Phone

REFERENCE'S ADDRESS

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize an investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release all parties from all liability for any damage that may result from furnishing same to you. I understand that this application, verbal statements by management, or subsequent employment does not create, express or implied contract of employment nor guarantee employment for any define period of time. If employed, I understand that I have been hired at the will of Kaw Nation and my employment maybe terminated at any time, with or without reason and with or without notice. *

Sign Here

Date *

ACKNOWLEDGEMENT

The Kaw Nation adopts the provisions of the Indian Self Determination & Education Assistance Act PL 93-638 as amended. In selection for employment, preference will be given to enrolled members of federally recognized Nations, providing other qualifying factors prove the enrolled member equal in merit to other applicants. I certify answers given on this application are true and complete to the best of my knowledge. In the event of employment, I understand false or misleading information given in my application or interview(s) may result in termination of employment regardless of length of employment, or cancellation of the job offer without notice. I understand I am required to abide by all rules, regulations, and laws of Kaw Nation. The applicant does hereby authorize The Kaw Nation to seek employment verification, information, or records from all former and current employers listed on this application. I hereby give my permission to Kaw Nation to investigate all statements given in this application or during interview(s), and I release from liability any person, company, agency, or corporation collecting or supplying such information to Kaw Nation and its employees. I understand that Kaw Nation will conduct criminal background check and sex offender registry search. FB Fingerprint check will be required for anyone working with children and other sensitive areas of Kaw Nation. I understand if I am employed by Kaw Nation in a position where I will be driving a Kaw Nation vehicle on a regular basis;any offer of employment I receive will be contingent on Kaw Nation verifying I have an acceptable driving record and a valid Driver's license. I authorize the Kaw Nation or its designated representative's) to obtain information regarding my driving record in any state at any time while I am employed by (or seeking employment with) Kaw Nation. In the event my report indicates I am a high risk High Risk Driver as defined in the glossary of the Fleet Safety Program, I understand I may be subject to dismissal. I further understand offers of employment are contingent upon passing a criminal background checkk, and in some designated positions accreditation through the Bureau of Indian Affairs (BIA). I further understand I will be required to pass a post offer of employment drug screen and/or medical review. I understand acceptance of an offer of employment does not create a contractual obligation upon Kaw Nation to continue to employ me in the future. I acknowledge Kaw Nation is an “at-will” employer. I understand that acceptance of this application does not necessarily guarantee employment or constitute an employment contract between Kaw Nation and myself.

I have read and understand the above statement.

Full Legal Name *

Signature Of Applicant *

Start signing your signature here

Date of Application *

FCRA NOTICE – BACKGROUND INVESTIGATION

Check box to acknowledge the following: *

In connection with your employment application with Kaw Nation this notice is intended to inform you that an investigative consumer report will be obtained on you from a consumer reporting agency for employment purposes. These purposes may include for hiring, retention, promotion or reassignment. The report may contain information about your character, general reputation, personal characteristics and mode of living, which may be based on personal interviews with sources such as your neighbors, friends or associates. The report may also contain information about you relating to your criminal information or history, credit history, driving and/or motor vehicle records, verification of your education or employment history, or other background checks.
You have the right, upon written request made within a reasonable time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to the Company and our background screening provider, National Crime Search, LLC, 3452 E. Joyce Blvd., Fayetteville, AR 72703 (888-527-3282). For information about National Crime Search, LLC’s privacy practices, see
www.nationalcrimesearch.com.

AUTHORIZATION FOR BACKGROUND INVESTIGATION:

By signing below you authorize the obtaining of investigative consumer reports by the Kaw Nation at any time after receipt of this authorization. To this end, you authorize any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested about you by National Crime Search, LLC and/or Kaw Nation. You understand that the scope of your authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow the Kaw Nation to conduct future screenings for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing.

Full Legal Name *

Other or Former Names *

Date of Birth: *This information will be used for background screening purposes only and no other purpose.

Social Security Number *

Street Address *

City *

County *

State *

Zip Code *

Driver's License Number *

State License Issued *

Name on License (if different than legal name): *

Email Address: *

Phone Number *

Signature

Start signing your signature here

Parent/Guardian Signature

Start signing your signature here

If the applicant is under 18 years old, both the applicant and a parent/guardian must sign the form.

Date: *

STATE LAW NOTICES AND DISCLOSURES – BACKGROUND INVESTIGATION | The following disclosures are being provided pursuant to state law.

MINNESOTA and OKLAHOMA: If you are a resident of Minnesota or Oklahoma, or applying for employment in one of these states, please check the box if you would like to receive a copy of your consumer report, free of charge, if one is obtained by Kaw Nation.

Check box to receive report.

MINNESOTA: If you are a Minnesota resident or applying for employment at a location within Minnesota, you have the right to submit a written request to National Crime Search, LLC | 3452 E Joyce Blvd, Fayetteville, AR 72703 | (888-527-3282) for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency must provide you with this disclosure within five days after its receipt of your request or the report was requested by the Company, whichever date is later. NEW JERSEY: If you are a New Jersey resident or applying for employment at a location within New Jersey, you acknowledge receipt of the New Jersey Fair Credit Reporting Act provisions. NEW YORK: If you are a New York resident or applying for employment at a location within New York, you have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting National Crime Search, LLC | 3452 E Joyce Blvd, Fayetteville, AR 72703 Phone: (888-527-3282). NEW YORK: If you are a New York resident or applying for employment at a location within New York, you acknowledge receipt of a copy of Article 23-A of the New York Correction Law. RHODE ISLAND: If you are a resident of Rhode Island or applying for employment at a location within Rhode Island, the Company may request a credit report from a consumer reporting agency in connection with your application for employment. VERMONT: If you are a Vermont resident or applying for employment at a location within Vermont, you acknowledge receipt of the NOTICE – BACKGROUND INVESTIGATION AND USE OF CREDIT INFORMATION. (Pursuant to Vermont law, employers requesting a credit report must provide job applicants/employees with a notice identifying the specific basis under 21 V.S.A. § 495i for use of the report.) WASHINGTON STATE: If you are a Washington resident or applying for employment at a location within Washington State, you have the right to request from National Crime Search, LLC | 3452 E Joyce Blvd, Fayetteville, AR 72703 | (888-527-3282) a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

A Summary of Your Rights Under the Fair Credit Reporting Act

Check to acknowledge the following: *

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.
You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
- a person has taken adverse action against you because of information in your credit report;
- you are the victim of identity theft and place a fraud alert in your file;
- your file contains inaccurate information as a result of fraud;
- you are on public assistance;
- you are unemployed but expect to apply for employment within 60 days.
  - In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.
- You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.
- You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer Revised Oct 2023 reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
- Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.
- Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
- Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.
- You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.
- You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address form the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).

The following FCRA right applies with respect to nationwide consumer reporting agencies:

CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE

You have a right to place a “security freeze” on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to preventcredit, loans, and services from being approved in your name without your consent.However, you should be aware that using a security freeze to take control over who getsaccess to the personal and financial information in your credit report may delay, interferewith, or prohibit the timely approval of any subsequent request or application you makeregarding a new loan, credit, mortgage, or any other account involving the extension ofcredit.

As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer’s credit file. Upon seeing a fraud alert display on a consumer’s credit file, a business is required to take steps to verify the consumer’s identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years. A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line increases, and account upgrades and enhancements.

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:

PLEASE ATTACH RESUME AND COVER LETTER HERE

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