‘pa White Buffalo Cultural Society Employment Application EYMIrenenee en) Full Name Date: last Fist Mailing Address: Actress city Province Postal Code Residential Address=_ Phone: Email ‘Social Insurance Date Available: Number. Position Applied for: Do you have any experience for this Yes NO Ifyes, how position? ooa long?, YES NO Have you ever been convicted of afelony? If yes, explain High School: Address: YES No From: To: Did you graduate? 1} [1 Diploma: College: Address: YES NO From To: Did you graduate? Cl 1 Degree Other: Address: YES NO From: To: Did you graduate? Cl (1 Degree ae CTT a ST Please list two professional references. Full Name: Relationship: Company: Phone:Address: Full Name: - Relationship: Company: Phone: Address: ean ms Company: Phone Address: ‘Supervisor: Job Title: Starting Salary'$ Ending Salary's Responsibilities: From: To: Reason for Leaving: Yes NO ‘May we contact your previous supervisor fora reference? —‘[] a ‘Company: Phone: Address: Supervisor: Job Title: Starting Salary'$ Ending Salary'$ Responsibilities: From: To: Reason for Leaving: YES NO May we contact your previous supervisor for a reference?‘ E] a a Gennes ' certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, | understand that false or misleading information in my application or interview may result in my release. Signature: Date: