Kaw Nation Careers Job Application COMPLETE APPLICATION BELOW PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Middle Name *Last Name *Birth Date *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone *Email AddressSocial Security Number *0 / 12ARE YOU KNOWN TO FORMER EMPLOYERS/REFERENCES BY ANOTHER NAME? *YESNOIF YES, WHAT NAME?ARE YOU LEGALLY ENTITLED TO WORK IN THE UNITED STATES? *YESNODO YOU HAVE A VALID DRIVER LICENSE? *YESNOLicense NumberStateTypeHAS YOUR LICENSE BEEN SUSPENDED WITHIN THE PAST 3 YEARS? *YESNOHAVE YOU EVER BEEN EMPLOYED BY KAW NATION? *YESNOIF YES, PROVIDE DATES OF EMPLOYMENT AND POSITION HELD.DO YOU HAVE RELATIVES CURRENTLY EMPLOYED BY KAW NATION? *YESNOIF YES, PROVIDE RELATIONSHIP AND POSITIONARE YOU AN ENROLLED MEMBER OF A FEDERALLY RECOGNIZED INDIAN TRIBE? *YESNOIF YES, WHAT TRIBE?IF YES, PROVIDE A COPY OF YOUR CERTIFICATE/TRIBAL ID WITH THIS APPLICATION.Choose FileNo file chosenDelete uploaded fileHAVE YOU EVER SERVED IN THE U.S. MILITARY/NATIONAL GUARD? *YESNOIF YOU ARE A VETERAN, DID YOU RECIEVE ANY TRAINING WHICH WOULD BE HELPFUL IN THE JOB FOR WHICH YOU ARE APPLYING? *YESNOIF YES, DESCRIBE:POSITION YOU ARE APPLYING FORDENTISTJOHNSON O’MALLEY COORDINATORLAND MANAGEMENT DIRECTORASSISTANT PROGRAM DEVELOPMENT/GRANT WRITING SPECIALISTDAYCARE TEACHERPHARMACISTJANITORDOCTOR OF MEDICINE (MD)DOCTOR OF OSTEOPATHIC MEDICINE (DO)PHYSICIAN ASSISTANTNURSE PRACTITIONERBACKGROUND INVESTIGATORCHILD SUPPORT SERVICES FINANCE SPECIALISTJOHNSON O'MALLEY SPECIALISTPATIENT BENEFITS/PRC COORDINATORADVOCATE SPECIALISTFLOATERCHILD SUPPORT SERVICES CASE SPECIALISTMULTI-PURPOSE AIDEHOW DID YOU FIND OUT ABOUT THIS JOB OPENING?RadioSocial MediaNewspaperWord of MouthEducationDO YOU POSSESS A HIGH SCHOOL DIPLOMA? *YesNoCAN YOU PROVIDE A COPY OF YOUR DIPLOMA OR GED? *YesNoYOUR NAME AS IT IS LISTED ON YOUR DIPLOMAHIGH SCHOOL NAMEHIGH SCHOOL LOCATION1.) COLLEGE/UNIVERSITY ATTENDEDCOLLEGE/UNIVERSITY LOCATIONYears CompletedCOURSE OF STUDY2.) COLLEGE/UNIVERSITY ATTENDEDCOLLEGE/UNIVERSITY LOCATIONYears CompletedCOURSE OF STUDY3.) COLLEGE/UNIVERSITY ATTENDEDCOLLEGE/UNIVERSITY LOCATIONYears CompletedCOLLEGE/UNIVERSITY LOCATIONEMPLOYMENT HISTORYBegin with your most recent employment and work backward. Include all jobs/positions held during the past ten years or periods of unemployment over 90 days. You may include jobs held more than ten years ago if relevant to position you are seeking. (Please fill out, do not state “see resume”).A.) EMPLOYERSTART DATEMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924END DATE (put current date if still employed)MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924EMPLOYER ADDRESSCityState/ProvinceZIP / Postal CodePOSITIONPART TIMEFULL TIMEDUTIESMONTHLY INCOME UPON START OF EMPLOYMENTUSDMONTHLY INCOME ON LAST DATE OF EMPLOYMENTUSDMAY WE CONTACT?YESNOSUPERVISORPHONE NUMBERREASON FOR LEAVINGB.) EMPLOYERSTART DATEMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924END DATE (put current date if still employed)MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924EMPLOYER ADDRESSCityState/ProvinceZIP / Postal CodePOSITIONPART TIMEFULL TIMEDUTIESMONTHLY INCOME UPON START OF EMPLOYMENTUSDMONTHLY INCOME ON LAST DATE OF EMPLOYMENTUSDMAY WE CONTACT?YESNOSUPERVISORPHONE NUMBERREASON FOR LEAVINGC.) EMPLOYERSTART DATEMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924END DATE (put current date if still employed)MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924EMPLOYER ADDRESSCityState/ProvinceZIP / Postal CodePOSITIONPART TIMEFULL TIMEDUTIESMONTHLY INCOME UPON START OF EMPLOYMENTUSDMONTHLY INCOME ON LAST DATE OF EMPLOYMENTUSDMAY WE CONTACT?YESNOSUPERVISORPHONE NUMBERREASON FOR LEAVINGD.) EMPLOYERSTART DATEMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924END DATE (put current date if still employed)MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924EMPLOYER ADDRESSCityState/ProvinceZIP / Postal CodePOSITIONPART TIMEFULL TIMEDUTIESMONTHLY INCOME UPON START OF EMPLOYMENTUSDMONTHLY INCOME ON LAST DATE OF EMPLOYMENTUSDMAY WE CONTACT?YESNOSUPERVISORPHONE NUMBERREASON FOR LEAVINGREFERENCESProvide three references capable of commenting on your ability to perform the work for which you have applied. Applicants should include references from their previous places of employment. Telephone numbers and addresses for reference contacts must be provided.REFERENCE #1 *TITLE *COMPANY *Phone *REFERENCE'S ADDRESS *REFERENCE #2 *TITLE *COMPANY *Phone *REFERENCE'S ADDRESS *REFERENCE #3 *TITLE *COMPANY *Phone *REFERENCE'S ADDRESS *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. 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 MVR indicates I am a High Risk Driver as defined in the glossary of the Fleet Safety Program, I understand I may be subject to dismissal. 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 further understand offers of employment are contingent upon passing a criminal background check, 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 employee me in the future. I acknowledge the Kaw Nation is an “at-will” employer. I have read and understand the above statements: (Provide signature below) *Sign HereYour browser does not support e-Signature field.DATE *Please list all names or alias that you are known by:MaidenNicknameOtherOtherSTATE LAW NOTICES AND DISCLOSURES - BACKGROUND INVESTIGATION Pursuant to state law, the following disclosures are provided to the state residents.CALIFORNIA applicants or employees only: By signing below, you acknowledge receipt of the NOTICE – BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. NEW YORK applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting American Checked Inc, 4870 S. Lewis, Ste. 120, Tulsa OK 74105; Phone: 1-800-975-9876. NEW YORK applicants or employees only: By signing below, you acknowledge receipt of a copy of Article 23-A of the New York Correction Law. WASHINGTON applicants or employees only: You have the right to request form American Checked Inc a written summary of you rights and remedies under the Washington Fari Credit Reporting Act. *Sign HereYour browser does not support e-Signature field.DATE *PRINTED NAME *NOTICE - BACKGROUND INVESTIGATIONCALIFORNIA, MASSACHUSETTS, MINNESOTA and OKLAHOMA applicants or employees only: Please check the box if you would like to receive a copy of your consumer report, free of charge, if one is obtained by the Company.CALIFORNIAMASSACHUSETTSMINNESOTAOKLAHOMAADDITIONAL INFORMATION (INTERNAL USE ONLY)In connection with my application for employment, I direct the following regarding my current employer. *Yes, my current employer may be contacted.No, my current employer may not be contacted.I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights *In connection with my application for employment, I direct the following regarding my current employer. I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights I authorize Company and Agency to use email communication with me to provide me with notices and information regarding any report or use of such report. If I do not have an email address or do not wish to share it, then communication will be by U.S. Mail, which will result in slower communication. *Sign HereYour browser does not support e-Signature field.DATEIn connection with your employment/ licensure (including contract or volunteer services) or application to rent a dwelling with Kaw Nation, notice is hereby given that a consumer report may be obtained from a consumer reporting agency for employment purposes. These reports may contain information about your character, general reputation, persona characteristics and mode of living, whichever are applicable. They may involve personal interviews with sources such as your neighbors, friends or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and /or motor vehicle records, education or employment history, or other background checks. You have the right, upon written request made within a reasonable time after the receipt of the notice, to request disclosure of the nature and scope of any investigative consumer report prepared by contacting the Company and AmericanChecked, 4870 South Lewis Ave., Suite 120, Tulsa, OK. 74105; Phone: 1-800-975-9876. For information about AmericanChekcked privacy practices, see http://americanchecked.com/privacy-policy. The scope of this notice and below authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow the Company to conducts future screening for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing. By signing below, I hereby authorize the obtaining of consumer reports and/or investigative consumer reports b the Company at any time after receipt of this authorization and throughout the course of my employment, if applicable. *Sign HereYour browser does not support e-Signature field.DATEPLEASE ATTACH RESUME AND COVER LETTER HEREDrag and Drop (or) Choose FilesSUBMIT APPLICATION