here

Fort Mojave Indian Tribe
Human Resources Department

500 Merriman Avenue Needles, CA 92363
Phone (760) 629-6147 Fax (760) 629-2322

APPLICATION FOR EMPLOYMENT

REMINDER: ALL APPLICATIONS MUST BE COMPLETED FOR EACH POSITION DESIRED AND MUST BE COMPLETELY FILLED OUT
OR THE APPLICATION WILL NOT BE PROCESSED.

Last Name First Middle Date

Street Address Cell Phone

City, State, Zip Email Address
P
E
R Position Desired: (One application per position, “Open” will not be accepted) Do you have a valid Driver’s

License?
S  Yes  No
O Have You Read the Job Description for the Position You Are Applying For? What date will you be
N   available to begin work? Yes No (If not, please do not hesitate to ask HR for Full Job Description if it applies)
A
L 

Are you available for full Are you claiming Fort Mojave Indian Tribe Preference? Yes No
time work?

FMIT Enrollment Number ____________ 
Yes  No

Are you related to anyone who works for Fort Mojave Indian Tribe?  Yes  No
Are you available for Part

Name:_____________________________ Department_________________
time work? 

Have you ever worked for the FMIT or its entities?  Yes  No Yes  No

Will you work overtime if
Have you been terminated from the FMIT or its Entities?  Yes  No

asked?  Yes  No

Are you legally eligible to work in the United States?  Yes  No

Name and Location Course of Study Graduated Years Degree,
Completed? Diploma,

E Certificate
D

High School
U  Yes

Or GED
C  No
A College
T  Yes

I  No
O Business or  Yes
N Trade

School  No

Please include Education Transcripts

FMIT Application, Continued Applicant’s Name: ________________________

EMPLOYMENT HISTORY

Start with your present or last job. Include any job-related military service assignments and volunteer activities.
You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities or other
protected status. Please fill out job duties as detailed as possible.

May we contact your past employers listed below?  Yes  No

Employer Dates Employed Job Duties:
From To

Address

Telephone: Hourly/Salary
Starting Final
Job Title Supervisor

Reason for Leaving

Employer Dates Employed Job Duties:
From To

Address

Telephone: Hourly/Salary
Starting Final
Job Title Supervisor

Reason for Leaving

Employer Dates Employed Job Duties:
From To

Address

Telephone: Hourly/Salary
Starting Final
Job Title Supervisor

Reason for Leaving

Employer Dates Employed Job Duties:
From To

Address

Telephone: Hourly/Salary
Starting Final
Job Title Supervisor

Reason for Leaving

FMIT Application, Continued Applicant’s Name: ____________________________

Please include professional and personal references. This does not include relatives. *This Application will NOT be
accepted if all four (4) references are not completed.

Name Address Phone Number Relationship

• 1.

• 2.

• 3.

• 4.

List other skills (typing, computer, etc.)

List professional, trade, business or civic activities and offices held.
(Exclude those which would reveal gender, race, religion, national origin, age, ancestry, disability or other
protected status.)

Have you ever been convicted or plead “no contest” to a felony, misdemeanor or other criminal offense in any
Tribal, State, Federal or other court, including but not limited to the Fort Mojave Tribal Court , for which the

records of such conviction or plea have not been expunged or sealed by the court? 

Yes  No If “Yes,” describe in full.

APPLICANT’S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an
employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this
organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge
Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be
changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges
such change in writing.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may
result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.

_________________________________________ __________________
Signature of Applicant Date