Indian Preference Office Employment Application

Personal Background

First Name(*)

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Last Name(*)

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Street Address/PO Box(*)

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City(*)

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State(*)

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Zip Code(*)

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Phone Number(*)

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Message Number

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Email Address(*)

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Date of Birth(*)

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Are you an enrolled member of the Salish and Kootenai Tribes?(*)

YesNo Invalid Input

If yes, provide your enrollment number.

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Are you an enrolled member of a different Federally Recognized Tribe?

YesNo Invalid Input

If yes, please provide your tribal enrollment #.

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If yes, please also provide enrollment verification.

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Have you ever been convicted of a misdemeanor in the last 3 years?(*)

YesNo Invalid Input

If yes, please explain the offense(s), the date(s) committed, and penalties/fines imposed.

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Have you ever been convicted of a felony?(*)

YesNo Invalid Input

If yes, please explain the offense(s), the date(s) committed, and penalties/fines imposed.

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Drivers License Information

Do you have a valid driver's license?(*)

YesNo Invalid Input

Drivers License #

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Expiration Date

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State of Issue

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Commercial or Regular

RegularCommercial Invalid Input

Class Type

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Endorsements

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Please submit a copy of your Drivers License.

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Work History

List your last three (3) employers, starting with the MOST RECENT:

Name of Employer

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Phone #

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Address

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Supervisor

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Dates of Employment

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Job Title

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Duties

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Reasons for Leaving

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Name of Employer

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Phone #

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Address

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Supervisor

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Dates of Employment

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Job Title

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Duties

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Reasons for Leaving

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Name of Employer

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Phone #

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Address

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Supervisor

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Dates of Employment

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Job Title

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Duties

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Reasons for Leaving

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List your knowledge, skills, and abilities that you feel would qualify you for the position(s) you are applying for.

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References

Only job-related references; no personal references.

Name

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Phone#

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Company Name

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Position

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Name

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Phone#

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Company Name

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Position

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Name

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Phone#

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Company Name

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Position

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Please enter the characters(*)

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