KTC Employment Application Form

01. Page 1

02. Page 2

03. Page 3

04. Page 4

05. Page 5

06. Uploads

KAYENTA TOWNSHIP USE ONLY

The Kayenta Township is an Equal Opportunity Employer. It is our policy to recruit, hire and promote persons without regard to race, color, sex, religion, national origin, political affiliation, physical or mental disability, or veterans' status. However, as an entity of the Navajo Nation, Navajo preference laws will apply when all other factors are equal. Give special attention to experience relative to the position for which you are applying for. Be specific and thorough. Include all relevant temporary, part-time, or voluntary work. Should your answers require more spaces than that provided on this application form, you may elect to attach additional sheets of 8-1/2 X 11" white paper or provide such additional information as you deem appropriate. Please number any such sheets to correspond with the application items section being responded to.

KAYENTA TOWNSHIP. P.O. BOX 1490 - Kayenta, Arizona 86033 Phone (928) 697-8451 - Fax (928) 697-8461 - E-mail: kayentatownship@mail.net

Application for Employment

Position Applying For: (See Job Announcement)

Position Title:

Department:

Referral Source:

Salary Expected:

Personal Information:

First, Middle and Last Name:

Social Security Number:

Current Address:

Mailing Address:

Please enter your mailing address if it is different from your current address.

Email Address:

Phone Number:

AUTHORITY TO WORK IN THE UNITED STATES: IT IS THE KAYENTA TOWNSHIP'S INTENTION TO HIRE ONLY AUTHORIZED WORKERS. IN COMPLIANCE WITH THE IMMIGRATION REFORM AND CONTROL ACT OF 1986. ALL EMPLOYEES WILL BE REQUIRED TO PROVIDE PROOF OF WORK ELIGIBILITY AT THE TIME OF EMPLOYMENT.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

01. Page 1

02. Page 2

03. Page 3

04. Page 4

05. Page 5

06. Uploads

KAYENTA TOWNSHIP USE ONLY

The Kayenta Township is an Equal Opportunity Employer. It is our policy to recruit, hire and promote persons without regard to race, color, sex, religion, national origin, political affiliation, physical or mental disability, or veterans' status. However, as an entity of the Navajo Nation, Navajo preference laws will apply when all other factors are equal. Give special attention to experience relative to the position for which you are applying for. Be specific and thorough. Include all relevant temporary, part-time, or voluntary work. Should your answers require more spaces than that provided on this application form, you may elect to attach additional sheets of 8-1/2 X 11" white paper or provide such additional information as you deem appropriate. Please number any such sheets to correspond with the application items section being responded to.

KAYENTA TOWNSHIP. P.O. BOX 1490 - Kayenta, Arizona 86033 Phone (928) 697-8451 - Fax (928) 697-8461 - E-mail: kayentatownship@mail.net

Availability:

Types of Appointment:

Check all that apply.

Regular

Emergency

Temporary

Other

If you answered OTHER in the previous question please specify.

Shifts Able to Work:

Check all that apply.

Day

Night

Any

Evening

Rotating

Schedules:

Check all that apply.

Part-Time

Full-Time

Will you accept a position that requires you to work weekends or holidays?

Yes

No

Would you be willing and able to travel if required?

Yes

No

Have you been known to previous employers/schools/references by any other name?

Yes

No

If you answered YES in the previous question, please provide name(s).

Are you presently or have you previously worked for the Kayenta Township?

Yes

No

If you answered YES in the previous question please give Dates, Title and Department.

Are you in any way related (i.e. blood, marriage, adoption, etc.) to any individual presently employed by Kayenta Township or a current member of the Kayenta Township Commission?

Yes

No

If you answered YES in the previous question please give name and relationship.

Licenses: Indicate type and license, registration or certification number and the state where issued (include driver's license).

Are you at least 18 years of age?

Yes

No

Have you been convicted of any violation (felony/misdemeanor) of Federal, State, Military, or Local Law in the last ten (10) years?

Yes

No

Have you been discharged or requested to resign or resigned in lieu of termination from any position for misconduct or unsatisfactory service in the last five (5) years?

Yes

No

If you answered YES in the previous question, explain.

NOTE: Responding "YES" to the previous two (2) questions does not constitute an automatic bar to employment.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

01. Page 1

02. Page 2

03. Page 3

04. Page 4

05. Page 5

06. Uploads

KAYENTA TOWNSHIP USE ONLY

The Kayenta Township is an Equal Opportunity Employer. It is our policy to recruit, hire and promote persons without regard to race, color, sex, religion, national origin, political affiliation, physical or mental disability, or veterans' status. However, as an entity of the Navajo Nation, Navajo preference laws will apply when all other factors are equal. Give special attention to experience relative to the position for which you are applying for. Be specific and thorough. Include all relevant temporary, part-time, or voluntary work. Should your answers require more spaces than that provided on this application form, you may elect to attach additional sheets of 8-1/2 X 11" white paper or provide such additional information as you deem appropriate. Please number any such sheets to correspond with the application items section being responded to.

KAYENTA TOWNSHIP. P.O. BOX 1490 - Kayenta, Arizona 86033 Phone (928) 697-8451 - Fax (928) 697-8461 - E-mail: kayentatownship@mail.net

History of Education:

Please Select

Do you have a High School diploma or GED?

Yes

No

Date of Graduation

MM

/

DD

/

YYYY

School Information:

Can include High School, College, University, Business, Vocational, Technical or Other.

Name of School and Location:

Credit Hours Completed:

Major:

Degree Earned and Year Received:

Office Skills:

Specify office machines you can operate and years of experience.

Specify computer equipment and software you can operate; and years of experience.

Typing Words Per Minute (WPM):

Shorthand or Equivalent WPM:

Specify word processing, spreadsheet and other computer software you can use.

List any other training, licenses, certifications, bilingual language(s), or experience you feel is important.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

01. Page 1

02. Page 2

03. Page 3

04. Page 4

05. Page 5

06. Uploads

KAYENTA TOWNSHIP USE ONLY

The Kayenta Township is an Equal Opportunity Employer. It is our policy to recruit, hire and promote persons without regard to race, color, sex, religion, national origin, political affiliation, physical or mental disability, or veterans' status. However, as an entity of the Navajo Nation, Navajo preference laws will apply when all other factors are equal. Give special attention to experience relative to the position for which you are applying for. Be specific and thorough. Include all relevant temporary, part-time, or voluntary work. Should your answers require more spaces than that provided on this application form, you may elect to attach additional sheets of 8-1/2 X 11" white paper or provide such additional information as you deem appropriate. Please number any such sheets to correspond with the application items section being responded to.

KAYENTA TOWNSHIP. P.O. BOX 1490 - Kayenta, Arizona 86033 Phone (928) 697-8451 - Fax (928) 697-8461 - E-mail: kayentatownship@mail.net

Employment History:

Beginning with your present or most recent position and working backward. List yourwork history for the past ten (10) years. Attach additional sheets if more space is needed.If more than one position has been held with the same employer, list each separately. Evenif you submit a resume, you must still complete this section. IN FULL, FAILURE TOPROVIDE COMPLETE AND ACCURATE INFORMATION WILL RESULT IN YOURAPPLICATION BEING DISQUALIFIED.

Name of Employer:

Address of Employer:

Supervisor's Name/Title/Phone Number:

Your Title:

Your Duties:

If you supervised others, include their numbers and titles.

Reason for Leaving:

Starting Date:

MM

/

DD

/

YYYY

Ending Date:

MM

/

DD

/

YYYY

Ending Salary:

Did you work part-time or full-time?

Part-Time

Full-Time

Hours Worked Per Week:

May we contact your employer/supervisors?

Yes

No

If you selected NO in the previous question please indicate exceptions and reasons.

Attach additional sheets if more space is needed.

Delete all uploads

Choose files or drag here

Military Service:

Branch of Service:

Rank:

Date Entered:

MM

/

DD

/

YYYY

Date Separated:

MM

/

DD

/

YYYY

Duties:

Are there any background factors that might interfere with your bondability?

Yes

No

If you answered YES to the previous question list and explain why.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

01. Page 1

02. Page 2

03. Page 3

04. Page 4

05. Page 5

06. Uploads

KAYENTA TOWNSHIP USE ONLY

The Kayenta Township is an Equal Opportunity Employer. It is our policy to recruit, hire and promote persons without regard to race, color, sex, religion, national origin, political affiliation, physical or mental disability, or veterans' status. However, as an entity of the Navajo Nation, Navajo preference laws will apply when all other factors are equal. Give special attention to experience relative to the position for which you are applying for. Be specific and thorough. Include all relevant temporary, part-time, or voluntary work. Should your answers require more spaces than that provided on this application form, you may elect to attach additional sheets of 8-1/2 X 11" white paper or provide such additional information as you deem appropriate. Please number any such sheets to correspond with the application items section being responded to.

KAYENTA TOWNSHIP. P.O. BOX 1490 - Kayenta, Arizona 86033 Phone (928) 697-8451 - Fax (928) 697-8461 - E-mail: kayentatownship@mail.net

The facts set forth in this application for employment are true and complete. I understand that any falsification of fact set forth herein may constitute cause for removal of my application from the selection process, or, if already hired, constitutes grounds for my dismissal. Kayenta Township has my permission to contact my previous employers and make such other inquiries may deemed appropriate by Kayenta Township to determine my suitability for employment for the position for which I am applying. I recognize that any and all inquiries made by Kayenta Township, its officers or assignees, and any verbal or written statements gathered therefrom shall remain solely the property of Kayenta Township and shall not be subject to or available for my reviews. By my signature, I agree to indemnify and hold harmless Kayenta Township, its officers and assignees from any cause of action either civil or criminal for any actions out of such initial or ongoing inquiries into my continuing suitability for employment as Kayenta Township may conduct.

Date

MM

/

DD

/

YYYY

Signature

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

01. Page 1

02. Page 2

03. Page 3

04. Page 4

05. Page 5

06. Uploads

KAYENTA TOWNSHIP USE ONLY

The Kayenta Township is an Equal Opportunity Employer. It is our policy to recruit, hire and promote persons without regard to race, color, sex, religion, national origin, political affiliation, physical or mental disability, or veterans' status. However, as an entity of the Navajo Nation, Navajo preference laws will apply when all other factors are equal. Give special attention to experience relative to the position for which you are applying for. Be specific and thorough. Include all relevant temporary, part-time, or voluntary work. Should your answers require more spaces than that provided on this application form, you may elect to attach additional sheets of 8-1/2 X 11" white paper or provide such additional information as you deem appropriate. Please number any such sheets to correspond with the application items section being responded to.

KAYENTA TOWNSHIP. P.O. BOX 1490 - Kayenta, Arizona 86033 Phone (928) 697-8451 - Fax (928) 697-8461 - E-mail: kayentatownship@mail.net

Verification

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20