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EMPLOYMENT APPLICATION
Instructions: Complete all infrormation on this application in its entirety, agree/date application and submit. Incomplete applications may not be processed. All applicants will be required to complete the employment application to be considered for an open position with the Pueblo of Santa Ana. Applications will be kept on file for a period of 6 months. It is the responsibility of the applicants to check/update their application.
*** This Position is for Santa Ana Pueblo Tribal Members Only ***

PERSONAL
Last name First Middle
Date
Street address
Telephone
City State Zip
Other telephone
Email address
Position desired
Desired pay
Date available to work Please indicate type of employment that interests you
Full time Part time Temporary On-Call
Are you 18 years of age or older?
Yes No
Have you ever applied for employment with The Pueblo of Santa Ana?
Yes - Month/Year? No
Have you previously been employed by The Pueblo of Santa Ana?
Yes - Month/Year? No
Have you ever been convicted of a felony or misdemeanor?
Yes No
Do you have a valid driver’s license?
Yes - State No
Can you, after offer of employment, submit verification of your legal right to work in the U.S.?
Yes No

EDUCATION
 
Name and location of school
Course of study
# of years completed
Did you graduate?
Degree or Diploma
High School
Yes
No
Business/Trade Technical
Yes
No
College
Yes
No
Graduate
Yes
No

 

NOTE: Any verification of training received, seminars attended, college courses taken, degrees or certificate of completion may be attached.

Other Education or Training:

EMPLOYMENT HISTORY
Beginning with your current or most recent employment, list your work history for the past 10 years. Include all part-time, internships, and periods of unemployment. “See resume” is not acceptable; please complete all and do not leave gaps in employment. If you need additional space, please continue on a separate sheet of paper.
1 Company name
Address
Name of Supervisor
Telephone

May we contact? Yes No
If not, Why?

Job Title
Dates of Employment
Salary
Job Duties
Reason for leaving
2 Company name
Address
Name of Supervisor
Telephone

May we contact? Yes No
If not, Why?

Job Title
Dates of Employment
Salary
Job Duties
Reason for leaving
3 Company name
Address
Name of Supervisor
Telephone

May we contact? Yes No
If not, Why?

Job Title
Dates of Employment
Salary
Job Duties
Reason for leaving
4 Company name
Address
Name of Supervisor
Telephone

May we contact? Yes No
If not, Why?

Job Title
Dates of Employment
Salary
Job Duties
Reason for leaving

OTHER QUALIFICATIONS
Summarize any additional skills/experience you feel are relevant to the position for which you are applying.

ADDITIONAL INFORMATION
MILITARY: Did you serve in the U.S. Armed Forces? If yes, in what branch?
Yes No
Dates of Service Rank Specialty
Special Military skills of training
LIST ANY IMMEDIATE RELATIVES EMPLOYED BY THE PUEBLO OF SANTA ANA:
Name
Relationship
Department

PROFESSIONAL REFERENCES
List three persons not related to you who have knowledge of your work experience and qualifications for the position for which you are applying.
  Name Relation Telephone
1
2
3

TRIBAL PREFERENCE INFORMATION
Are you a member of The Pueblo of Santa Ana? If yes, what is your enrollment number?
Yes No
Are you a spouse of a member of The Pueblo of Santa Ana? If yes, state name of spouse
Yes No
Are you related to a member of The Pueblo of Santa Ana? If yes, state member(s) name
Yes No
Are you a member of another Pueblo/Tribe? If yes, which Pueblo/Tribe?
Yes No

Upload your resume (optional)

APPLICANT CERTIFICATION AND AUTHORIZATION
I certify that all of the information given in this application and in the attachments or supporting documents is true, accurate and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission, as well as any misleading statements or omissions, will be cause for denial of employment or my immediate dismissal if I have been hired based upon any false or misleading information that I provided in this application or supporting documents, regardless of when or how discovered. I hereby authorize The Pueblo of Santa Ana to use this information in determining my qualifications for employment. I further authorize The Pueblo of Santa Ana to investigate all information and statements contained herein, and I give The Pueblo of Santa Ana permission to verify any and all information regarding my previous employment and release all parties from liability for any damages that may result from furnishing such information to The Pueblo of Santa Ana.

I have read and understand the above statements.

Date
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