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Form BIA 4432

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BIA 4432

Revised February 1999

INSTRUCTIONS FOR COMPLETION OF FORM BIA 4432


Instructions to Applicants (Form BIA-4432):
It is the responsibility of the individual establishing evidence of entitlement to Indian preference in employment to submit
as much background information as possible to verify eligibility for preference.
Category A:
If you are a member of a Federally -recognized tribe, you may contact either your tribe or the BIA Agency Office
servicing your tribe for completion of this category. O ne of the following procedures will apply and you will be advised
by the BIA or your tribal representative:
- If the Bureau maintains the tribal enrollment records or has a copy of a current tribal roll in its custody, the
Bureau verification and signature is sufficient;
-If your tribe has contracted the maintenance of tribal enrollment records, and the tribe certifies, then the
verification must be countersigned by authorized Tribal representative(s);
-The absence of 638 contract of the tribal enrollment records, and the tribe certifies, the verification must be
countersigned by authorized Bureau representative.
Category B, C, and D:
If you are claiming preference based on any of these categories, you should provide as much information as possible
regarding your family history. This will be the only information which the Bureau will have to certify to your
descendancy.
Instructions to the Division of Tribal Government Services:
This form has been designed for verification that an individual is entitled to preference in employment. If the applicant
does not meet the tribal enrollment criteria, the form should not be completed. Upon verification by Area Director,
Superintendent, or designed BIA Representative, the individual will be entitled to preference in employment.
Instructions to the Personnel Office:
Receipt of this properly verified form, together with OF-612, Optional Application for Federal Employment entitles an
applicant to preference in employment.

Form BIA 4432


Revised February 1999
VERIFICATION OF INDIAN PREFERENCE FOR EMPLOYMENT

IN BUREAU OF INDIAN AFFAIRS AND INDIAN HEALTH SERVICE ONLY

To establish eligibility for Indian preference for employment with BIA/HIS. Complete one of the
Categories below and submit with your OF-612, Option Application for federal Employment.
Category
A

MEMBERS OF FEDERALLY RECOGNIZED INDIAN TRIBES, BANDS FOR COMMUNITIES


This is to certify that the person named below is a member of tribe indicated:
_______________________________ ____________ ________________________________
Full Name

Date of Birth

Tribal Affiliation

I certify that the above information was taken from the official membership records of the
____________________ Tribe and acknowledge that falsification and misrepresentation of this
information is punishable under Federal Law.
_________________________ ___________ OR _________________________ ___________
Tribal Representative

Date

BIA Representative

Date

_________________________

______________________________________

Title

Title

______________________________________
Agency Name

Category
B

DESCENDANTS OF MEMBERS OF FEDERALLY RECOGNIZED INDIAN TRIBES, BANDS


OR COMMUNITIES WHO WERE RESIDING ON ANY INDIAN RESERVATION ON JUNE
1, 1934
This is to certify that the person named below as 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 applicants family history is outlined on the attached family history
chart:

_________________________ ___________

Name of Individual

Date of Birth

_______________________________________
Reservation of Residence on June 1, 1934

________________________________

_______________________________________

Ancestor

Tribal Record of Affiliation

_____________

Date

_______________________________________
BIA Representative

_______________________________________
Title

_______________________________________
Agency Name

Form BIA 4432


Revised February 1999

Category
C

PERSONS WHO POSSESS AT LEAST ONE-HALF DEGREE INDIAN BLOOD DERIVED


FROM TRIBES INDIGENOUS TO THE UNITED STATES:
This is to certify that I have reviewed the documentation to support the below listed individuals claim to
the possession of at least one-half degree Indian blood. The attached family history chart outlines the
individuals family history:

______________________________ ____________ __________________________________


Name

Date of Birth

Degree of Blood and Tribal Derivation

Based On:
______________________________________ ________________________________ ___________
______________________________________ BIA Representative
Date
______________________________________ _____________________________________________
______________________________________ Title
Name Records

Category
D

___________________________________________________ ______
Agency

PERSONS OF ESKIMO OR OTHER ABORIGINAL PEOPLES OF ALASKAN DESCENT:


This is to certify that the person names below has been established to my satisfaction that he is qualified
for Indian preference because of his possession of Eskimo or other aboriginal peoplesblood of Alaska.
The attached family history charts outlines the individuals family history.
______________________________
Name

__________ ______________________________________
Date of Birth

Alaska Native Group

_______________________________________________________________
Record on Which Based

__________________________________ ______________
BIA Representative

Date

__________________________________________________
Title

__________________________________________________
Agency

Form BIA - 4432


Revised February 1999
FAMILY HISTORY
for Categories B,C, and D

Paternal Grandfather
Father
Paternal Grandmother
Applicant
Maternal Grandfather
Mother
Maternal Grandmother

Family History continuation:

Great-Great Grandfather
Great Grandfather
Great-Great Grandmother
Paternal Grandfather
Great-Great Grandfather
Great Grandmother
Great-Great Grandmother

Great-Great Grandfather
Great Grandfather
Great-Great Grandmother
Paternal Grandmother
Great-Great Grandfather
Great Grandmother
Great-Great Grandmother

Great-Great Grandfather
Great Grandfather
Great-Great Grandmother
Maternal Grandfather
Great-Great Grandfather
Great Grandmother
Great-Great Grandmother

Great-Great Grandfather
Great Grandfather
Great-Great Grandmother
Maternal Grandmother
Great-Great Grandfather
Great Grandmother
Great-Great Grandmother

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