Alchemy Tribal Services Employment Application

Personal Information

Today's Date *

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Desired Salary *

Date Available *

Position Applied For *

Are you legally authorized to work in the United States? *

Yes

Have you ever been convicted of a felony? *

Yes

A felony may not necessarily disqualify you from employment. If yes, please explain.

Employment History

Employer 1

Company Name *

Address *

Phone *

Start Date * +

End Date * +

Position *

Salary *

Supervisor/Manager *

Reason for Leaving *

May we contact? *

Yes

Phone Number *

Employer 2

Company Name *

Address *

Phone *

Start Date * +

End Date * +

Position *

Salary *

Supervisor/Manager *

Reason for Leaving *

May we contact? *

Yes

Phone Number *

Employer 3

Company Name *

Address *

Phone *

Start Date * +

End Date * +

Position *

Salary *

Supervisor/Manager *

Reason for Leaving *

May we contact? *

Yes

Phone Number *

Professional References

Reference 1

Name *

Title *

Email Address

Phone *

Reference 2

Name *

Title *

Email Address

Phone *

Reference 3

Name *

Title *

Email Address

Phone *

Tribal Affiliation | Military Service

Tribe *

Military Branch + Rank at Discharge/Dates *

Please submit a copy of your resume.

Skills, Experience + Additional Information

Describe any specialized training, apprenticeships, volunteer work and skills. *

Describe software and equipment you have experience with (Office Suites, Mac, QuickBooks, Adobe, Oracles, etc.). *

Security clearances, licensing and professional memberships. *

Other information you believe may be helpful in consideration of your application. *

I certify that the facts described in this Application for Employment are true. I understand that if I am employed, any false statements, omissions or misrepresentations given in my application or interview(s) may result in my dismissal.

I understand, also, that I am required to abide by all rules and regulations of the employers.

I authorize Alchemy Tribal Services or its parent company, JW Industries Group, to investigate any of the facts described in this application and I release Alchemy Tribal Services or JW Industries Group from any liability resulting from such an investigation.

The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that effect is executed by the employer and employee in writing.

I understand that employment, if offered, will be at the will of the Employer and myself and may be terminated for any reason by either party.

I also understand that the use of illegal drugs and alcohol is prohibited during employment. I am willing to submit to preemployment drug and alcohol testing, and agree to random alcohol and drug screening during employment.

By submitting this application, I affirm that I have read and agree to all disclosures and conditions included in this application. *

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