NAPI ~~ Navajo Pride Employment Application

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Employment Application - NAPI (Navajo Agricultural Products Industry)

Please fill out this application as completely as possible
(Incomplete or inaccurate applications will be discarded.)

** You can also print this application and mail it to our office, click here for printable app. **(Microsoft Word Document)

Position Desired: Position Desired(2): Position Desired(3):

Referred By:

Name: * Last: * First: * Middle:

Your Email Address:

Other Names Used if applicable:

Street Address: City: State: Zip:

Telephone Home: Work/Message Phone: Contact Person:

Social Security Number: Gender:

Drivers License Number: State: Expiration Date:

Have you had any traffic violations within the last 3 years ? Yes: No: ** If Yes, Please Explain:

Have you been convicted of a DWI/DUI within the last 3 years ? Yes No: ** If Yes, Specify Date:

Have you ever been convicted of a felony ? Yes: No: ** If Yes, please explain :

Claim Navajo Preference ? Yes: No: Census No.: Chapter Affiliation:

Claim American Indian Preference ? Yes: No: Tribe:

Claim Veterans Preference? Yes: No:

** If Yes, please provide the following below:

Branch: Entrance Date:

Discharge Date: Type of Discharge:

Are you related to anyone withing NAPI ? Yes: No:

If Yes, please state name, relationship, and department:

It is the policy of NAPI to avoid the practice and the appearance of nepotism in employment.

In carrying out this policy, no person shall be hired to a position, which is within the same departmentof a relative or under the supervision of a relative.

List any physical impairments (if any):

*How is your hearing?

Limited

Good

Excellent

*How is your vision?

Limited

Good

Excellent

*How is your speech?

Limited

Good

Excellent

In case of emergency, notify (name, address, phone number):

Any offer of employment may be contingent on applicant passing a job related physical examination and alcohol/drug test.

NAVAJO AGRICULTURAL PRODUCTS INDUSTRY IS A DRUG-FREE WORKPLACE

Name: Home Phone: Work Phone: Cell Phone:

Email Address:

Positions Applied For: (1) (2):

EDUCATION
High/Prep/GED School Name & Location	From/To: Month/Year	Graduate? Yes: No:	Type of Degree/Diploma
Major Subjects Completed

College or University Name and Location	From/To: Month/Year	Graduate? Yes: No:	Type of Degree/Diploma
Major Subjects Completed

College or University Name and Location	From/To: Month/Year	Graduate? Yes: No:	Type of Degree/Diploma
Major Subjects Completed

College or University Name and Location	From/To: Month/Year	Graduate? Yes: No:	Type of Degree/Diploma
Major Subjects Completed

Vocational, Trade, Business, or On-Line Name and Location	From/To: Month/Year	Graduate? Yes: No:	Type of Degree/Diploma
Major Subjects Completed

GENERAL INFORMATION

List On-The-Job-Trainings:

List Farm Equipment, implements, and/or tools that you can operate:

List the types of Computer, PC software and office machines you can operate:

Computer Profiency: Excellent Good: No Experience: ** What is your typing/keyboard speed? WPM

Please Check All That Apply:	Languages	Understand	Speak	Read	Write
	English
	Navajo

Please provide information on honors, professional memberships, certifications, licenses, etc., that may be relevant to the position.

* In addition to the specific skills, education and experience required, all of which are necessary qualifications for the position; any candidate for a position with NAPI must demonstrate through his or her prior employment and other work related activities: integrity, competence, professional behavior, demonstrate ability to perform in team work, operating knowledge in which you are applying, customer service oriented, reasonable job stability, and dependability, as determined by NAPI in its reasonable discretion. NAPI retains the right to contact the applicant’s prior employers and others to determine if these necessary qualifications are met.

Are you employed right now ? Yes: No:

If yes, may we inquire of your present employer? Yes: No:


EMPLOYMENT HISTORY ** List all employment for the last 10 years.
Please begin with the most recent job:

(1). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(2). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(3). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(4). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(5). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(6). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(7). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(8). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(9). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

(10). Dates of Employment: (From/To:)	Name/Phone Number of Employer	Position Held/ Pay Rate:
Description of Work:	Reason For Leaving:

References:
* List at least one previous supervisor or employer as a reference *

Name	Address	Business & Home Phone Number	Years Known
		Business: Home:
		Business: Home:
		Business: Home:

ACKNOWLEDGEMENTS AND AUTHORIZATIONS – Please Check Each Statement.

	"I acknowledge that NAPI may terminate my employment for cause if I have made any false statement or representation in applying for a job with NAPI, and that such misrepresentation shall constitute “just cause” for such termination under the Navajo Preference in Employment Act and any other applicable law. I further acknowledge that no one at NAPI has given me any justifiable expectation of being hired, and that NAPI’s action on my application shall be in the sole discretion of NAPI, as limited only by applicable law."
	"I authorize NAPI-Human Resources to conduct a background check."
	"I authorize NAPI-Human Resources to obtain a Driver’s License Record prior to processing my application for referral."

Referrals to the appropriate department shall be made only if a position is available and only upon the submission of a completed and satisfactory application where the applicant meets all necessary and minimum qualifications.

The Foregoing Information is True and Complete to the Best of My Knowledge. Yes: No:

Your Full Name: Date: November 20, 2008