# CERTIFIED employment application PACKET > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/tribal%3Amescalero_apache%3Abd636ce33dba8678 ## Record - **Collection:** Tribal code - **Document type:** Tribal code ## Text CERTIFIED employment application PACKET Mescalero Apache School Human Resource Office P.O. Box 230 Mescalero, NM 88340 Phone (575) 464-4431 Fax (575) 464-0053 name ___________________________________________________________________ MAILING ADDRESS __________________________________________________ ___________________________________________________________________________ Telephone # _________________________________________________________ EMAIL: _________________________________________________________________ To the Applicant: Please read the following and sign below: 1. The Mescalero Apache School is an equal opportunity employer and does not discriminate on the basis of race, sex, color, national origin, religion, or disability. 2. You must complete this Application Packet in full and provide all information requested including the following:  Application/Questionnaire for Certified Employment and Resume  Official College/University Transcripts  Current New Mexico License (ie., Teaching, Administrative, Counseling, Coaching, etc.)  Current New Mexico License (ie. Speech Therapist, Social Worker, Occupational Therapist, etc.)  3 Current Signed Letters of Reference  Authorization for Release of Information An incomplete application packet will not be considered. 3. The provision of any false, incomplete, or misleading statements in this application packet, on any other documents submitted with it, or as part of any other phase of the application process, will result in the applicant’s disqualification or discharge, regardless of when the misrepresentation or omission is discovered. 4. Applicants are subject to employment and education history checks, drug testing, AND background investigations, including mandatory fingerprinting, as a condition of the application process for employment consideration. 5. All offers of employment are contingent upon the satisfactory completion of background investigations. Criminal convictions shall not automatically bar an applicant from obtaining employment with the school, but pursuant to the Crime Control Act of 1990 and Public Law 101-630 (Indian Child Protection and Family Violence Prevention Act), may be basis for refusing employment. I have read and understood the foregoing: __________________________________________ Applicant’s Signature P.O. Box 230 ~ 249 White Mountain Drive Mescalero, NM 88340 Phone: (575) 464-4431 Fax: (575) 464-0053 Information contained in this application/questionnaire is for official use only. APPLICATION/QUESTIONNAIRE FOR CERTIFIED EMPLOYMENT Notice to Applicant: The Crime Control Act of 1990, Public Law 101-647 (codified in 42 United States Code § 13041), requires that employment applications for child care positions have applicants sign a receipt of notice that a criminal record check will be conducted as a condition of employment. POSITON DESIRED First Choice ___________________________________________________________________________ Second Choice ___________________________________________________________________________ Third Choice 1. Full Name Last Name ___________________________________________________________________________ First Name Middle Name Jr., II, etc. 3. Other Names Used – Maiden name, from a former marriage, alias(s), or nickname(s). Name 5. Place of Birth City County 2. Date of Birth Month Day Year 4. Telephone Number ( ) 6. Social Security Number State 7. Residence – List where you have lived; beginning with the most recent and working back 5 years. All periods in the last 5 years must be accounted for in you list. Month/Year Month/Year **Incomplete information will disqualify you from further consideration** Street Address City State Zip Code 1) To Present Month/Year Month/Year Street Address City State Zip Code 2) To Month/Year Month/Year Street Address City State Zip Code 3) To Month/Year Month/Year Street Address City State Zip Code 4) To Month/Year Month/Year Street Address City State Zip Code 5) To 7. a. Residence on an Indian Reservation – List any Indian Reservations in which you have lived or worked in the last 5 years. Name of Indian Reservation Last Name Application/Questionnaire Continued First Name Middle Initial Jr., II, etc. Social Security Number 8. Education – List the schools you have attended. High School Address, City, State, Zip Code Date Graduated Diploma / GED Received College/University Address, City, State, Zip Code Date Graduated Degree / Diploma / Other Received College/University Address, City, State, Zip Code Date Graduated Degree / Diploma / Other Received College/University Address, City, State, Zip Code Date Graduated Degree / Diploma / Other Received College/University Address, City, State, Zip Code Date Graduated Degree / Diploma / Other Received 8. a. Graduate Hours Completed Beyond Bachelor Degree Beyond Master Degree 8. b. Certification – List all licenses ie. Teaching, Administrative, Counseling, Coaching, Social Worker, Speech Therapist, Educational Diagnostician, Occupational Therapist, etc. Please use a separate sheet if necessary. State Level Type Endorsements State Level Type Endorsements 9. Teacher Application Supplement The Mescalero Apache School is located on the Mescalero Apache Reservation in South Eastern New Mexico. Please state your qualifications for working with a predominately Mescalero Apache student enrollment: Outline some of the things you will do as a teacher which will allow you to establish a harmonious relationship with the students. Explain how your own personal values will be reflected in your teaching. Comment on MOTIVATION Comment on CLASSROOM MANAGEMENT Comment on PLANNING Application/Questionnaire Continued First Name Middle Initial Last Name Jr., II, etc. Social Security Number 10. Employment – List your employment activities, beginning with the present and working back. Each year must be accounted for without breaks. For periods of unemployment, list dates and “unemployed” or “attending school.” Month/Year **Incomplete information will disqualify you from further consideration** Month/Year Employer Name Position Title 1) To Employer Address City Supervisor’s Name Telephone Number ( Reason For Leaving Month/Year Month/Year Employer Name ( Month/Year Month/Year ( Month/Year Reason For Leaving Telephone Number ) Position Title State Other Employer Reference Zip Code Telephone Number ) ( Employer Name ) Position Title City Telephone Number ( Zip Code ( Employer Name 5) To Employer Address Supervisor’s Name Other Employer Reference ) Telephone Number Reason For Leaving ) State City Supervisor’s Name Telephone Number Position Title Telephone Number ( Zip Code ( Employer Name 4) To Employer Address Month/Year Other Employer Reference City Reason for Leaving ) State ) 3) To Employer Address Supervisor’s Name Telephone Number Position Title Telephone Number Reason For Leaving Zip Code ( City Supervisor’s Name Month/Year Other Employer Reference ) 2) To Employer Address Month/Year State ) State Other Employer Reference Zip Code Telephone Number ( ) Last Name Application/Questionnaire Continued First Name Middle Initial Jr., II, etc. Social Security Number 11. Professional References – List 5 people who have known you Professionally for at least 5 years. 1) Name Address 2) Name Address 3) Name Address 4) Name Address 5) Name Address Do not include relatives or anyone who is listed elsewhere on this application. Month /Year Dates Known Month/Year To Telephone Number □ Day □ Night ( ) State Zip Code Dates Known Month/Year To Telephone Number □ Day □ Night ( ) State Zip Code Dates Known Month/Year To Telephone Number □ Day □ Night ( ) State Zip Code Dates Known Month/Year To Telephone Number □ Day □ Night ( ) State Zip Code Dates Known Month/Year To Telephone Number □ Day □ Night ( ) State Zip Code City Month /Year City Month /Year City Month /Year City Month /Year City Please continue on next page Last Name Application/Questionnaire Continued First Name Middle Initial Jr., II, etc. Social Security Number 12. Background Information – For all questions, provide all additional required information in the space provided or on a separate sheet. Ensure full name and social security number is on any attachments to this application. **Incomplete information will disqualify you from further consideration** 12. a. Have you been arrested for, charged with, or convicted of, been imprisoned, been on probation, or been on parole YES for any offense(s)? Include all offenses where you have been found guilty, pled guilty or nolo contendere (no contest). (Leave out traffic fines of less than $150.00.) NO If “YES”, use item 12.i. to provide the date, explanation of violation, place of occurrence, and the name and address of the police department or court involved. 12. b. Have you been convicted by a military court-martial? YES NO If “YES”, use item 12.i. to provide the date, explanation of the violation, place of occurrence, and the name and address of the military authority or court involved. 12.c. Are you now under charges for any violation of law? YES NO YES NO YES NO If “YES”, use item 12.i. to provide the date, explanation of the violation, to include a description of what led to your arrest, disposition of the arrest(s) or charge(s) and attach a copy of the police report and nay related court documents. 12. f. Have you ever been found guilty of, or entered a plea of nolo contendere (no contest) or guilty to , any felonious offense, or any of two or more misdemeanor offenses under Federal, State, or Tribal Law involving crimes of violence, sexual assault, molestation, exploitation, contact or prostitution, crimes against persons; or offenses committed against children? YES NO If “YES”, use item 12.i. to provide the date, explanation of the violation, disposition of the arrest(s) or charge(s), place of occurrence, and the name and address of the police department or court involved. 12. g. Have you illegally used any controlled substance, for example, marijuana, cocaine, crack cocaine, hashish, narcotics (opium, morphine, codeine, heroin, etc.), amphetamines, depressants (barbiturates, methaqualone, tranquilizers, etc.), hallucinogenics (LSD, PCP, etc.), or illegally used prescription drugs? YES NO YES NO If “YES”, use item 12.i. to provide the date, explanation of violation, place of occurrence, and the name and address of the police department or court involved. 12.d. Have you been fired from any job for any reason, did you quit after being told that you would be fired, or did you leave any job by mutual agreement because of specific problems? If “YES”’ use item 12.i. to provide the date, an explanation of the problem, reason for leaving, and the employer’s name and address. 12. e. Have you ever been arrested for or charged with a crime involving a child? If “YES”, use item 12.i. to provide the date(s) of use, identify the controlled substance(s) and/or prescription drugs used, and the number of times each was used. Include any treatment or counseling received. 12. h. Have you been involved in the illegal purchase, manufacture, trafficking, production, transfer, shipping, receiving, or sake of any narcotic, depressant, stimulant, hallucinogen, or cannabis, for your own intended profit or that of another? If “YES”, use item 12.i. to provide information relating to the type of substance(s), the nature of the activity, and nay other details relating to your involvement with illegal drugs. 12. i. Use this space or attach additional sheets to provide explanations of any questions you may have answered “YES” to. Certification that my Answers are True My statements on this application/questionnaire, and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a false or fraudulent answer to any question or item on any part of this application or its attachments may be grounds for not hiring me, or firing me after I begin work, and may be punishable by fine or imprisonment. ____________________________________________________ Applicant’s Initials Date I certify that my responses to the above questions are made under penalty of perjury, which is punishable by fine or imprisonment, and that I have received notice that a criminal history records check will be conducted and is a condition of employment. I understand my right to obtain a copy of any criminal history report made available to the Mescalero Apache School and my rights to challenge the accuracy and completeness of any information contained in the report. __________________________________________________________________________________________________________________ Applicant’s Printed Name Applicant’s Signature Date P.O. Box 230 ~ 249 White Mountain Drive Mescalero, NM 88340 Phone: (575) 464-4431 Fax: (575) 464-0053 AUTHORIZATION fOR RELEASE OF INFORMATION Information contained in this Release is for official use only. I authorize any investigator, or other duly accredited representative of the agency conducting my background investigation, to obtain any information relating to my activities from individuals, schools, residential management agents, employers, criminal justice agencies, or other sources of information. This information may include, but is not limited to, my academic, residential, achievement, performance, attendance, disciplinary, employment history, and criminal history record information. I, further authorize any investigator, or other duly accredited representative of the Mescalero Apache School, who is conducting my background investigation, to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for assignment to, or retention in a position working with children. I understand that I may request a copy of such records as may be available to me under the law. I authorize custodians of records and other sources of information pertaining to me to release such information upon request of the investigator, or other duly accredited representative authorized above regardless of any previous agreement to the contrary. I understand that the information released by records custodians and sources of information is for official use by the Mescalero Apache School only for purposes of determining my suitability for employment with the Mescalero Apache School. Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid from the date signed until termination of my affiliation with the Mescalero Apache School. Signature (sign in black ink) Printed Name Date Signed Other Names Used Current Address Social Security Number State Zip Code Contact Number ( ) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/tribal%3Amescalero_apache%3Abd636ce33dba8678. Public record. Not legal advice.