Colusa Indian Community Council -
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Employment Application

Employee Form

  • PERSONAL INFORMATION
    • We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law.Equal access to employment, services and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

    • Date Format: DD slash MM slash YYYY
      Proof of citizenship or immigration status will be required upon employment.
  • EDUCATION
    • (Describe any specialized training, apprenticeship, skills and extra-curricular activities)
  • MILITARY INFORMATION
  • LANGUAGES
    • List any languages you can speak, read and/or write other than English:
  • SPECIALIZED SKILLS
      By touch Y/N
  • PERSONAL REFERENCES
    • YOU MUST HAVE 3 REFERENCES (not related to you and not your current or previous employer)

  • EMPLOYMENT EXPERIENCE
    • Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Employment experience must cover 5 years.

    • Employed

    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Hourly Rate/Salary


    • Employed

    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Hourly Rate/Salary


    • Employed

    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Hourly Rate/Salary


    • Employed

    • Date Format: DD slash MM slash YYYY
    • Date Format: DD slash MM slash YYYY
    • Hourly Rate/Salary

  • STATEMENT AND CONSENT
    • In compliance with the Privacy Act of 1974, the following information is provided:?Solicitation of the information contained within this application is authorized by 25 U.S.C 2701 et.seq. The purpose of the requested information is to determine the eligibility of individuals to be employed in a gaming operation. The information will be used by The National Indian Gaming Commission members and staff who have need for the information in the performance of their official duties. The information may be disclosed to appropriate Federal, Tribal, State, Local or Foreign Law Enforcement and Regulatory Agencies when relevant to civil, criminal or regulatory investigations or prosecutions or when pursuant to a requirement by a tribe or The National Indian Gaming Commission in connection with the hiring or firing of an employee, the issuance or revocation of a gaming license or investigations of activities while associated with a tribal or gaming operation. Failure to consent to the disclosures indicated in this notice will result in the tribe's being unable to hire you in any position.

    • A false statement on any part of your application may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished by fine or imprisonment (US Code,Title 18, Section 1001).

      Due to the nature of our business, you will be subject to an extensive background investigation including criminal history. Therefore, as a part of this application, you hereby authorize the CICC and its agents to investigate your references, and to make an independent investigation of your character, conduct, credit, education, employment and criminal records including the Federal Bureau of Investigation and/or any other clearance agencies and give the right to access any and all of your files and/or records maintained by these agencies.

Employment Application

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