TERO Hiring Hall Application
Page 2
TERO HIRING HALL APPLICATION
Tribal Employment Rights Ordinance Office
P.O. Box 306◦Fort Hall, ID 83203
Phone: (208) 478.3848◦Fax: (208) 478.3756
Instructions: This application will be maintained in the TERO Office for a period of one (1) year. Please complete all sections of this application. Submit or attach the following documents: 1) Tribal ID or CIB, 2) Drivers License or CDL; 3) OSHA 10 or 30 Certification Card and/or Any other TOSHA Regulatory Training Certifications/Cards; 4) DD-214/Military ID Card; 5) Other Certifications and documents that may verify eligibility for preference and job qualifications.
Today’s Date ______Name ______SSN______
Mailing Address ______City______State______Zip ______
Physical Location (If different from above) ______
Home/Cell Phone ______Message Phone ______DOB ______Male ______Female _____
Email Address:______
Are you younger than 16? Yes ____ No____ Between 18 – 64? Yes _____ No ______Older than 64? Yes _____ No ______
Are you a member of the Shoshone-Bannock Tribes? Yes ____ No ____ Enrollment No.: ______(Attach copy Tribal ID or CIB)
Are you a member of aFederally Recognized Tribe? Yes _____ No _____ Tribal Affiliation:______
**If you are a member of another Tribe, you must provide documentation of Indian status to be eligible for Indian Preference**
Are you a Non-Indian? Yes _____ No _____ If you are a supporter of a Native American Family, please identify the qualifying name and provide documentation of family: ______
Do you reside on the Fort Hall Indian Reservation? Yes____ No ____ Are you Head of Household? Yes____ No ____
Driver’s License/CDL No.: ______State Issued:______Expiration Date:______CDL Medical Registry No.:______
Are you a Veteran? Yes _____ No ____ Branch of Service ______(Please provide copy of DD-214/Veteran’s ID card)
Do you have a Disability? Yes _____ No _____ If Yes, please identify______
Are you a member of a Union? Yes ____ No ____ If yes, please Identify Local NumberLocation: ______
Employment Desired – ListJob(s) you qualify for:
1) ______2______3______
Types of Employment Seeking: Part-Time, Full Time, Seasonal (Please circle) Total hour(s) available per week ______
Are you legally able to Work in the U.S.? Yes ____ No ____
Do you have a HS Diploma or GED?Yes _____ No_____What year obtained?______
Do you have a Technical Certificate or College Degree? Yes _____ No ______Please list______
Education (High School)
Name ______Address ______
City ______State ______Zip ______Phone ______
(College)
Name ______Address ______
City ______State ______Zip ______Phone ______
(Trade School)
Name ______Address ______
City ______State ______Zip ______Phone ______
RECENT EMPLOYMENT: (If not applicable, list work performed on a volunteer basis or personal references.)
(1)Employer______Address______
City ______State ______Zip ______Phone ______
Supervisor ______Dates Worked: From ______To______
Work Performed ______
RECENT EMPLOYMENT (CONTINUED): (If not applicable, list work performed on a volunteer basis or personal references.)
(2) Employer______Address______
City ______State ______Zip ______Phone ______
Supervisor ______Dates Worked: From ______To______
Work Performed ______
(3) Employer______Address______
City ______State ______Zip ______Phone ______
Supervisor ______Dates Worked: From ______To______
Work Performed ______
(4)Employer______Address______
City ______State ______Zip ______Phone ______
Supervisor ______Dates Worked: From ______To______
Work Performed ______
Are you Computer Literate? Yes ____ No ____List all computer programs used:
Word Processing ______Spreadsheets ______
Data Bases ______Graphics______
Desktop Publishing ______Other ______
Mark your Clerical Skills:
Typing, WPM ______Shorthand, WPM ______Medical Terminology Yes ______No ______Legal Terminology Yes ______No ______
Do you possess any of the following Certifications?
OSHA 10 or 30 Certification ______Aerial Lift ______Forklift ______Confined Space ______Fall Protection ______
Food Handler Certificate ______First Aid/CPR ______Haz-Mat or Hazwoper ______EMT or CNA______Certified Flagger ______
Other Certifications or Licensures: ______
I certify that the facts contained in this application are true and correct to the best of my knowledge. I have received a copy of the TERO Hiring Hall Procedures. I give TERO permission to verify employment and education background as specified in the application. This organization gives Indian Preference in Employment and Training in accordance with Title VII, Section 703 (1) and the Executive Order 11246 and the Shoshone-Bannock Tribal Employment Rights Ordinance. All TERO Referrals may be subject to pre-screening as a condition of their employment.
Signature ______Date ______
TO BE COMPLETED BY TERO STAFF:
Date received ______/______/______Received By: ______
ITEMS ON FILE: DL CDL Tribal ID Resume OSHA 10/30 Card SS Card OROther Documents:______
Application Complete: Yes_____ No_____ If not complete, what items are needed: ______
Application Incomplete Notice sent ______Date entered into skills bank ______/______/______
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