• To prevent the delay of Background investigations.

    Applications must be filled out completely.

    List current working phone numbers.

    List employment from the past five (5) years. Attach all certified transcripts/diploma's.

    Please provide copy of CDIB (if applicable).

     

    DO NOT USE RELATIVES FOR PERSONAL REFERENCES.

  • Personal Information Sheet

    Background Investigation
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  • Supplemental Application

    Part 1
  • Where You Have Lived: (List addresses for the past 5 years.)

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  • Education

  • Browse Files
    Cancelof
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    Cancelof
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    Cancelof
  • Professional License or Certification

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  • Employment History

    List employment history for the last five (5) years, most recent employment first. Include military service and periods of unemployment during the five (5) year's)
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    Do not list your spouse, former spouse, relatives or persons appearing elsewhere on this form
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  • Supplemental Application

    Part 2- Background Information
  • Your answers to the following questions should include ALL convictions (by being found guilty,
    entering a plea of nolo contendere or a plea of guilty). OMIT (1) traffic fines of $150.00 or less;
    (2) any violation of law for which you were tried as a juvenile or under a Youth Offender law;
    (3) any conviction set aside under the Federal Youth Corrections Act or similar State or Tribal
    Law, or (4) any convictions whose record was expunged under Federal, State or Tribal Law.

  • I certify the information provided on this form is true and complete.

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  • Signatures and Authorization for Release of Information

    Please read the following carefully and thoroughly
  • I understand that in applying for a position involving regular contact with or control over Indian
    children or any child care services position, I must undergo a background check as mandated by
    the Indian Child Protection and Family Violence Prevention Act, Pub. L. 101-630, 25 U.S.C.
    ‘3207, and the Crime Control Act of 1990, Pub. Law 101-647,42 U.S.C. ‘13041. Child care
    services positions include, but are not limited to child protective services, social services, health
    and mental health care, child/day care, education whether or not directly involved in teaching,
    foster care, residential care, recreational or rehabilitative programs, and detention correctional or
    treatment services.

    I certify that all the information on this form and any attached sheets is true, correct complete
    and made in good faith. I understand that false or fraudulent answer to any question may be
    grounds for not hiring me, or for firing me after I begin work. I understand that any information I
    give may be investigated for purposes of determining my fitness to have responsibility for the
    safety and well-being of children and suitability to occupy a position involving regular contact
    with or control over Indian children. I consent to the release of information about my ability,
    fitness and suitability for employment with the Cheyenne and Arapaho Tribes by employers,
    schools, law enforcement agencies, and other individuals and organizations to investigators,
    personnel, specialist, and other authorized employees of the Cheyenne and Arapaho Tribes. I
    understand that financial or lending institutions, medical institutions, hospitals, health care
    professionals, or some other sources of information, may require the separate Authorization for
    Release of Information I have signed. I also understand that I may challenge the accuracy and
    completeness of any information obtained during the investigation of my background.

    Public Law 101-647 requires that the application state that it is signed under penalty of perjury,
    with the applicable Federal punishment for perjury.

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  • Personnel Information

  • Personnel or Applicant

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  • College

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  • Personal References

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  • Signature of Personnel or Applicant 

  • I certify the information provided on this form is true and complete.

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  • Should be Empty: