Office: 406.673.3031 Fax: 406.673-3023 ~ PO Box 470 ~ 353 Old Hays Rd. ~ Hays, MT 59527
Human Resources
www.islandmtn.com
Date Application Received: ___/___/_____
EMPLOYMENT APPLICATION
Island Mountain Development Group (IMDG) is an Equal Opportunity / Practices Indian Preference in accordance the Tribal Employment Rights Ordinance of the Fort Belknap Indian Community (“TERO”).
ISLAND MOUNTAIN DEVELOPMENT GROUP
353 Old Hays Road P.O. Box 470 Hays, Montana 59527 Business Office: 406.673.3031
Business Fax: 406.673.3023 Email: [email protected]
EMPLOYMENT APPLICATION INSTRUCTIONS
For proper processing, each page in this packet must be printed on a separate sheet of paper. Double- sided copies are not acceptable. Read these instructions thoroughly before beginning the application.
• Read all pages of this Employment Application.
• Complete the entire application thoroughly and legibly in blue or black ink. If a question does not apply to you, write “N/A” (not applicable) in the space provided for your response. Do not leave anything blank.
• If you need more space for any response, attach additional pages to the end of the application packet and identify your additional information by question number.
• Enclose copies of requested job advertisement documents and a copy of the following:
• Two (2) valid forms of Identification
• Tribal Identification or Certificate of Indian Blood (if applicable)
• A resume may not be substituted for any part of the application packet.
• Bring your completed application to our office (at the address listed at the top of this page) or send via U.S. Mail, e-mail, or fax, sending to the attention of the Human Resources Department.
• If the position that you are applying for has a filing deadline, your application MUST BE RECEIVED by IMDG by 5:00 P.M. on the date of the deadline. Your application may not be considered if IMDG does not receive it by the deadline.
• You are responsible for providing complete, accurate, and truthful responses. Misstatements or omissions may result in your application being rejected.
THIS APPLICATION WILL ONLY BE CONSIDERED FOR NINETY (90) DAYS OR UNTIL THE POSITION YOU ARE APPLYING FOR IS FILLED
Each position requires its own application, and it is the responsibility of the applicant to submit an application for each position.
I have read and understand the above instructions:
Signature: __________________________________ Date: _____/_____/_______
Date Received: ________
Personal Information
Last Name First Name Middle Name Today’s Date
Street Address City State Zip Code
Home Phone: (_____)________-________________
Work Phone: (_____)________-________________
Email: ________________________________
Are you legally eligible to work in the U. S.? _____Yes _____No Are you an Enrolled Member in a Federally Recognized Native American Tribe? _____Yes______No
Enrollment Number: __________________
Tribe: ______________________________
Are you 18 or older? ____Yes ____No
Title of Position Applying For: Date Available to Work
Have you been previously interviewed or employed by the Island Mountain Development Group? ____Yes ____No If Yes, list date(s) and job title(s):
Do you have any relatives currently working for the Island Mountain Development Group? ____Yes _____No If Yes, list names and relationship to you:
Are you employed now? If so, may we contact your current employer? ____Yes _____No IMDG Employee who referred you:
Education
(Note: You will be required to furnish transcripts)Name and Location # Years Completed Major Area of Study Degree/Diploma received High School
College
Graduate School
Employment History
Please provide the following information for your previous three employers, beginning with the most recent. Please attach an additional page if necessary. Resumes may not be submitted in lieu of completing the following employment information.Employer: Dates Employed:
From_____________ To______________
Job Title:
Address:
Telephone: Job Duties:
Reason for Leaving:
Employer: Dates Employed:
From_____________ To______________
Job Title:
Address:
Telephone: Job Duties:
Reason for Leaving:
Employer: Dates Employed:
From_____________ To______________
Job Title:
Address:
Telephone: Job Duties:
Reason for Leaving:
Describe your qualifications for the position you are applying for: (Please include skills, special training, etc.) __________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________
If applicable, please list any special awards, honors, scholarships, or offices held that are relevant for this position.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
References:
Please list names of supervisors, managers, or others who can comment directly on your abilities:Name Address Phone # Relationship/Occupation Years Known
Native American Preference / Veteran Preference
(Note: You will be required to provide supporting documentation)Do you qualify for Native American preference? _____Yes ______No
If yes, please list Tribe: _______________________ Enrollment Number: __________________
Please attach supporting documentation (for example, copy of Tribal ID card or Certificate of Indian Blood (CIB)) Do you qualify for veteran’s preference? ______Yes ______No
If yes, please check one of the following:
___Veteran (defined as a person separated under honorable conditions who has served on active duty for at least 181 days, or honorably discharged by reason of disability incurred while on active duty).
___Disabled Veteran (defined as a veteran having a currently existing, compensable service-connected disability as adjudicated by the U.S. Veterans Administration or the retirement board of one of the branches of the Armed Forces).
If you selected veteran’s preference, please attach supporting documentation (for example, Form DD-214)
Signature_________________________________________ Date________________________________
PLEASE READ CAREFULLY AND SIGN
Island Mountain Development Group (IMDG) is an Equal Opportunity Employer, and except to the extent required by Native American Preference and Veteran Preference, IMDG prohibits discrimination on the basis of race, color, creed, religion, sex, pregnancy, age, national origin, marital status, physical or mental disability, or any other basis protected by applicable law. This applies to all employment decisions, including hiring, promotion, termination, and other matters affecting terms and conditions of employment.
IMDG is a drug-free work environment. I understand that I may be subject to pre-employment drug testing before I am permitted to commence work with IMDG. I also understand that I may be subject to a pre-employment background check to investigate my criminal background and other matters related to my suitability for employment with IMDG. I understand that a separate disclosure and consent form will be provided to me prior to any background check.
I authorize IMDG to contact my current and former employers, schools, references, and other persons or organizations that I have named in this application for the purpose of reviewing my application for employment (with the exception of my current employer if I marked “No” on page 3 of this application). I further release my current and former employers, schools, references and other persons or organizations named in this application from any liability resulting from the information released. I authorize employers, schools, and other persons and organizations named in this application to provide any information or transcripts requested.
******
I certify that all of the information provided in this employment application is true and complete. I understand that any falsification or omission of information made by me may disqualify me from further consideration of employment or, if hired, may result in my termination at any time during the period of my employment, regardless of the amount of time that has passed.
____________________________________ ________________
Signature of Applicant Date
