Application Form

Full Name*:

Date*:

Full Address*:

Phone*:

Email*:

Date Available*:

Are you over 18?*: YesNo

Are you an Akwesasne Tribal member?*: YesNo

Where you ever convicted of a crime?*: NoYes

If yes, what for?:

Position applied for*:

Location preferred*:

Have you ever worked for this company?*: NoYes

If yes, when?:

Did an employee refer you?*: NoYes

how did you hear about the position?*:

How many hours can you work weekly?:

Can you work night?*: YesNo

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position*:

Resume attachment:

High School*:

Address*:

From*:

To*:

Did you graduate?*: YesNo

Diploma:

College/Other:

Address:

From:

To:

Did you graduate?: YesNo

Diploma:

Company:

Phone:

Location:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference: YesNo

Company:

Phone:

Location:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference: YesNo

Company:

Phone:

Location:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference: YesNo