EMPLOYMENT APPLICATION

110 W. 38th Ave. STE 200E
Anchorage, Alaska 99503
907-868-8250

Note to applicants: You must apply for a current open position for your application to be considered.

APPLICANT INFORMATION

Alaska Native/Tribal Affiliation: *

If Ahtna Shareholder Descendent/Spouse, specify name of Ancestor/Spouse:

How did you hear about us: *

If "Other", please state source:

First Name *

Middle Name

Last Name *

Street Address: *

City: *

State: *

Zip: *

Primary Contact Number *

Secondary Contact Number

Email Address: *

Have you ever applied to, or worked for this company before? *

Yes

No

If YES, when?

Are you legally eligible for employment in the U.S.A? (Verification will be required) *

Yes

No

Do you have a valid driver's license? *

Yes

No

Since your 18th birthday, have you been convicted of a felony or felony-reduced-to misdemeanor conviction by any court? You may omit conviction of a misdemeanor while under age 18 if the record was sealed under Penal Code 1203.45, minor traffic violations for which the fine was imposed under $400.00 or less, any offense that was finally settled in juvenile court or referred to the youth authority, or any conviction specified in Health and Safety Code Section 11361.5 which pertains to certain marijuana offenses. *

Yes

No

If YES, please explain:

0/255 words

Have you ever been convicted of a federal crime, as defined in 42 USC 1320a-7(i) or been excluded from participating in any federal or state health care program? *

Yes

No

If YES, please explain:

0/255 words

1320a-7(i) "Convicted" defined -

1. When a judgment or conviction has been entered against the individual or entity by a Federal, State, or local court, regardless of whether there is an appeal pending or whether the judgment of conviction or other record relating to criminal conduct has been expunged;

2. when there has been a finding of guilt against the individual or entity by a Federal, State, or local court;

3. when a plea a guilty or nolo contendere by the individual or entity has been accepted by a Federal, State, or local court; or

4. when the individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program where judgment of conviction has been withheld.