APPLICATION FOR EMPLOYMENT                                

POWERAIN SYSTEMS, INC. l One Enterprise Dr l Tower, MN 55790

Phone: 800-943-8866 | Fax: 218-753-4206

Owned and operated by the Bois Forte Band of Chippewa

 (Proof of U.S. citizenship or immigration status will be required upon employment)

Position Applied for:                                                                                                                                                             

Type of Employment Desired:            (  ) Full Time     (  ) Part Time    (  ) Temporary

On what date would you be available for work?                                                                                /             /            

The best time to contact you at home is:                                                                                        :             AM / PM                                      

If you are under 18, can you furnish a work permit?                                                                  (  ) Yes                 (  ) No

Have you ever been employed here before?                                                                                (  ) Yes                 (  ) No

If yes, give dates                                                                                                                                                                                                                              

Are you currently employed?                                                                                                         (  ) Yes                 (  ) No

May we contact your current employer?                                                                         (  ) Yes                 (  ) No

Have you ever been convicted of a felony or crime relating to theft?                        (  ) Yes                 (  ) No

If Yes, please explain                                                                                                                                                                                                         

Are you a Veteran of U.S. Military Service?                                                                               (  ) Yes                 (  ) No

Are you legally eligible for employment in this country?                                                (  ) Yes                 (  ) No

If the job requires, are you able to lift 50 lbs?                                                                               (  ) Yes                 (  ) No

Are there any shifts which you cannot work?                                                                              (  ) Yes                 (  ) No

EDUCATIONAL BACKGROUND

EMPLOYMENT EXPERIENCE

(Start with your present or last job. Include Military service assignments & volunteer activities. Please include Street, City, State & Zip Code)

REFERENCES

(Please include Street, City, State & Zip Code.  DO NOT include family members or significant others.)

Describe any specialized Education, Training, Skills, or abilities:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

Name, Phone Number and Address of Person(s) to be notified in an emergency:                                                                                                                                                                                                                                                                                                                                                                                                                                                    

SIGNATURE, CERTIFICATION, & INFORMATION RELEASE

• I understand that acceptance of employment does not create a contractual obligation upon the employer and that this employment relationship is considered “at will”.  This means that you are not required or guaranteed to work for the company for a set period of time and that you are free to terminate your employment at any time and for any reason with or without notice or progressive discipline.  The Company is also free to terminate your employment at any time and for any reason with or without notice or progressive discipline.
• I certify that the answers given herein are true and complete to the best of my knowledge and also understand that false or misleading information upon this application will result in my disqualification or discharge from employment.
• I authorize investigation of all statements and references contained in this application for employment as deemed necessary and further grant any former employer and/or government agency to release confidential information about me to the Bois Forte Development Corporation.  This release is valid for one (1) year after the date of my signature hereon.  A photocopy of this release shall be as valid as the original.

Signature of Applicant                                                                                                                                                     Date