Chehalis Tribal Loan Fund
Application for Employment
PLEASE TYPE OR PRINT. Complete the entire application. The Purpose of the requested information is to
determine the eligibility of individuals to be employed by the Loan Fund. A false statement on any part of your
application may be grounds for not hiring you or termination of employment after you begin work. All
applications are kept on file for six months.
Position Applying For:
Name (Last, First, Middle):
Other names under which
you have attended school or
been employed:
Street Address:
Social Security Number:
City, State & Zip:
Home Phone:
Work Phone:
Are you eligible to work in the United
States?
Are you 18 years of age or older?
Are you currently employed at The
Confederated Tribes of the Chehalis
Reservation?
Have you ever been employed by The
Confederated Tribes of the Chehalis
Reservation?
Do you have a valid driver’s license?
Yes
No
Yes
Yes
No
No
Have you ever been convicted of a
crime or have criminal action pending?
Other Phone:
If NO, please provide your date of birth:
If YES, what is your current job title & department?
Yes
No
If YES, dates of employment & reason for leaving:
Yes
No
Yes
No
If YES, State of issuance, license #, and expiration
date:
If yes, please explain (a conviction will not
necessarily disqualify an applicant, but may be
considered due to the financial nature of the job):
EDUCATION: Please attach verification of all post-high school degrees granted.
Did you
If No, # of
If Yes, date
Name of School
City/State
graduate?
years left to
of
graduate
Graduation
High School:
Yes
No
Other School:
Yes
No
College:
Yes
No
College:
Yes
No
Degree
received
Major
Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.
Chehalis Tribal Loan Fund Employment Application
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SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems
and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)
ADDITIONAL INFORMATION: Please state any additional information you feel may be helpful to us in considering your
application:
WORK EXPERIENCE-Please complete the following regarding your employment history for the past five years. Begin with
your current or most recent employer. Attach additional sheets using the same format if necessary. Omission of prior
employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military
or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”
PLEASE NOTE: Chehalis Tribal Loan Fund reserves the right to contact all current and former employers for reference
information.
Dates Employed (most recent
position)
From:
To
Starting Salary:
Title:
Full time
Part-time
If part-time, # hrs./wk:
Organization Name and Address:
Final Salary:
Supervisor’s Name, Title and
Phone #:
Other Reference Name, Title and
Phone #:
Contact my current references:
At any time
Only if I am a finalist candidate
Primary duties:
Reason for Leaving:
Dates Employed (most recent
position)
From:
To
Title:
Starting Salary:
Full time
Part-time
If part-time, # hrs./wk:
Organization Name and Address:
Final Salary:
Supervisor’s Name, Title and
Phone #:
Other Reference Name, Title and
Phone #:
Primary duties:
Chehalis Tribal Loan Fund Employment Application
Contact my current references:
At any time
Only if I am a finalist candidate
Reason for Leaving:
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REFERENCES – Please list three references:
Name:
Type:
Relationship:
Work
Personal
Work
Personal
Work
Personal
Address:
Phone:
VERIFICATION OF INDIAN PREFERENCE – Please complete this section if applicable.
Are you an enrolled Chehalis Tribal
member?
yes
Are you the spouse of an enrolled
Chehalis Tribal member?
yes
Descendant of an enrolled Chehalis
Tribal member?
yes
Enrolled member of another Tribe?
yes
Enrollment Number:
Spouse’s Name:
Spouse’s Enrollment Number:
Enrolled parent(s)’s name(s):
Enrollment Number:
Tribe:
Please attach enrollment certificate.
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION The Chehalis Tribal Loan Fund
does not discriminate on the basis of sex, age, race, color, religion, marital status, national origin, disability, and Veteran status.
However, Native American preference applies. Interviews are given on a competitive basis, using job-related factors. After a
written application has been received and reviewed, because of the large number of applications received, not everyone who
applies for a vacant position will necessarily be interviewed.
I certify that I have answered truthfully and have not knowingly withheld any information relative to my application. I understand
that any misrepresentation or material omission of this application will result in my being eliminated from further consideration. I
further understand that, if accepted for employment, my misrepresentation or material omission which becomes known to the
Chehalis Tribal Loan Fund may result in immediate termination. I authorize all previous employers/supervisors, including all
persons with and for whom I have worked, to give the Chehalis Tribal Loan Fund’s representative any and all information
regarding my previous employment.
I release the Chehalis Tribal Loan Fund and all previous employers/supervisors from liability for any damages that may result
from furnishing information to the Chehalis Tribal Loan Fund.
I understand that, if selected, I will be required to provide proof of identity and legal right to work in the United States prior to
actual employment with the Chehalis Tribal Loan Fund.
In consideration of my employment, I agree to conform to the Chehalis Tribe’s Personnel Policies and Procedures, including
periodic drug/substance testing with or without prior notice.
I agree to submit to a pre-employment drug screen.
I understand that a background check may be required prior to any employment offer. I understand that this application will only
be considered if all information as requested in the job announcement, in addition to the information requested on this application,
has been submitted.
Applicant Signature: _______________________________________
Chehalis Tribal Loan Fund Employment Application
Date: ________________
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