Please provide at least (7) years of employment history

Employment History

 Please include explanation of any gaps in employment:

 Summarize job related skills and qualifications/certificates

 Typing (WPM)

 Computer Programs:

 Other Office Equipment:

 Are there any other skills, or abilities that you feel may be helpful to us in considering your application?

 Have you ever served in the United States Armed Forces?   Yes     No

 Are you claiming Veteran preference?    Yes    No

 List duties while serving, including special training that is relevant to the position for which you have applied.

 Are you claiming Indian preference?    Yes    No

References

List two work related references and one personal reference (EXCLUDING Relatives)    

Pre-Employment Statement Substance Testing Form

I freely and voluntarily give my permission to submit to urinalysis and or other screening or tests as shall be determined by United Tribes Technical College (UTTC) under its administration of applicable regulations of the U.S. Department of Transportation (DOT) including 49 CFR Parts 40 and 382, UTTC Policy and in substantial compliance with applicable state statues pertaining to a Drug Free Workplace, if any, in the selection process of all applicants for employment, for the purpose of determining the presence of, and content of, any and all of the following substances:

1. Amphetamines
   • Methamphetamine
   • MDMA (Ecstasy)
2. Cannabinoids
3. Cocaine
4. Phencyclidine (PCP)
5. Opiates
   • 6-Acetyl Morphine (Heroin)
   • Codeine
   • Morphine
6. Alcohol

I also understand and acknowledge that I may be subject to non-DOT screening and testing under UTTC Policy as set forth in the policy.

I further agree to and hereby authorize the release of the results of said tests to UTTC and to UTTC’s medical review officer and its Service Agents as provided in the policy.

I understand that a negative test is a pre-condition of employment with UTTC and the refusal to submit to testing or a positive test result will result in the rejection of my application or the rescinding of a conditional offer of employment. I also understand that it is not the purpose of this screen or test to identify any disability I may have and that preemployment screening and testing activities are conducted in compliance with the ADA requirements applicable to UTTC if any.

Mandatory Question
During the past two years, have you tested positive or refused to test an any pre-employment drug or alcohol test administered by an employer to which you applied, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules?
 Yes    No

I further agree that a reproduced copy of this form shall have the same force and effect as the original. I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

Pre-Employment Statement

I understand and agree that:

1. The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentationor omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification for refusal ofemployment, or, if employed, termination from United Tribes employment.
2. I understand that any offer of employment I may receive from United Tribes Technical College is contingent upon successfulcompletion of the college’s total pre-employment screening process, including United Tribes Technical College receiving references thatit considers satisfactory.
3. If United Tribes Technical College decided to engage an investigative consumer reporting agency to report on my education or personalhistory, I authorize it to do so. I understand that it will do so if it has a business related reason for doing so. If a report is obtained, Iunderstand that upon written request, the name of the agency will be provided to me so that I may obtain information regarding thenature and substance of information contained in the report.
4. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of United Tribes TechnicalCollege and understand that my employment and compensation can be terminated with or without cause or notice, at any time, atthe option of either United Tribes technical College or myself. I further understand that no manager or representative of United TribesTechnical College, other than the President has any authority to enter into an agreement with me for employment for any specifiedperiod of time or to make any agreement different from or contrary to the foregoing. I further understand that any such agreement, ifmade, shall not be enforceable unless it is in writing and signed by me and by the individual designated above.
5. I certify that my response to the above questions are made under penalty and perjury and I understand that a criminal history checkwill be conducted and is a condition of employment.