Verification Of Indian Preference
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1
2
3FORM BIA – 4432
OMB Control # 1076-0160
Expiration Date: 11/30/2014
VERIFICATION OF INDIAN PREFERENCE FOR EMPLOYMENT
IN THE BUREAU OF INDIAN AFFAIRS AND THE INDIAN HEALTH SERVICE
Complete one of the categories as stated in the Instructions and submit this form with your application for Federal employment.
C
A - M
F
-
I
T
, B
C
ATEGORY
EMBERS OF
EDERALLY
RECOGNIZED
NDIAN
RIBES
ANDS OR
OMMUNITIES
This is to certify that the person named below is a member of the tribe shown:
______________________________________________
_____________
_____________________
Full Name
Enrollment No.
Date of Birth
Tribal Affiliation
I certify that the above information was taken from the official membership records of the ________________ Tribe (or records
maintained for the Tribe by the BIA) and acknowledge that falsification and misrepresentation of this information is punishable
under Federal Law, 18 U.S.C. 1001.
And if required, verification by the BIA Official maintaining the
Certification by Tribal Official:
official tribal rolls that the individual is listed on enrollment
list maintained by the BIA at the request of the tribe.
____________________________ ________
_______________________________________ ________
Signature
Date
Signature of BIA Official
Date
______________________________________
__________________________________
_____ ________
Print Name & Title of Tribal Official
Name/Title
Agency
C
B - D
M
F
-R
I
T
, B
C
ATEGORY
ESCENDANTS OF
EMBERS OF
EDERALLY
ECOGNIZED
NDIAN
RIBES
ANDS OR
OMMUNITIES WHO
I
R
J
1, 1934
WERE RESIDING ON ANY
NDIAN
ESERVATION ON
UNE
I certify that the person named below has established to my satisfaction that he/she is a descendant of an enrolled member of the
tribe named below and that he/she was living on an Indian reservation on June 1, 1934. The applicant’s family history is outlined on
the attached family history chart.
_____________________________
____________________________________________________
_______________
Full Name
Date of Birth
____________________________________________________
__________________________________________
Reservation of Residence on June 1, 1934
Full Name of Ancestor & Tribal Affiliation
Title and source of records upon which this is based:
________________________________ ________
BIA Official
Date
___________________________________________
__________________________ ________________
Title
Agency
C
C - P
-
I
ATEGORY
ERSONS WHO POSSESS AT LEAST ONE
HALF DEGREE
NDIAN BLOOD DERIVED FROM TRIBES INDIGENOUS
U
S
.
TO THE
NITED
TATES
I certify that I have reviewed the documentation to support the below listed individual’s claim to possess at least one-half degree
Indian blood. The applicant’s family history is outlined on the attached family history chart and official records.
__________________________________________________
______________ ___________________________________
Full Name
Date of Birth
Degree of Blood and Tribal Derivation
Title & Source of Records upon which this is based:
____________________________________ ________
BIA Official
Date
___________________________________________
Official Records of Tribal Affiliation & Blood Degree
_______________________________ ________________
State or Academic Recognition of Indigenous Status
Title
Agency
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