| Question | Answer |
|---|---|
| Form Name | Colusa Casino Application Form |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | employment application colusa casino form |
EMPLOYMENT
APPLICATION
We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Equal access to employment, services and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.
PERSONAL INFORMATION
Position(s) Applied For
Date Of Application
Last Name
First Name
Middle Initial
Telephone Number
Address
City
State
Zip Code
Can you provide required proof of eligibility to work ? |
Yes .... |
No |
Proof of citizenship or immigration status will be required upon employment.
If you are under 18, can you furnish a work permit if it is required? |
Yes .... |
No |
Have you ever been previously employed by our organization? |
Yes .... |
No |
If so, dates of employment___________________________________________ Position __________________________________________
Are you currently employed? |
|
Yes .... |
No |
|
May we contact your present employer? |
|
Yes .... |
No |
|
Availability to work: |
Full Time ... Part Time |
|||
What shifts are you available to work? |
Day |
Swing |
Grave |
All |
Are you able to meet the attendance requirements? |
|
Yes .... |
No |
|
Do you have any objection to working overtime if necessary? |
|
Yes .... |
No |
|
Can you travel if required by this position? |
|
Yes .... |
No |
|
Are any persons related to you presently employed with us? |
|
Yes .... |
No |
|
List Names:__________________________________________________________________________________________________________ |
||||
Have you ever been convicted of a crime? |
|
Yes .... |
No |
|
If yes, please explain (a conviction will not automatically bar employment): __________________________________________________
Desired rate of pay: __________________________________________________________________________________________________
EDUCATION
School Name & Address
Course of Study
Graduated?
High School
College
Technical
MILITARY INFORMATION
Have you ever served in the Armed Forces? __________ |
If YES, Branch_________________________ |
Type of discharge________________________________ |
Dates of service from _________________ to _____________________ |
LANGUAGES
List any languages you can speak, read and/or write other than English:
____________________________________ ___________________________________ ____________________________________
SPECIALIZED SKILLS
List equipment operated and any specialized training, apprenticeship, computer programs and/or applicable skills.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
PERSONAL REFERENCES
YOU MUST HAVE 3 REFERENCES (not related to you and not your current or previous employer)
1. ______________________________________________________________________________________________________________
(Name)(Phone #)
_____________________________________________________________________________________________________________
(Address)
1. ______________________________________________________________________________________________________________
(Name)(Phone #)
_____________________________________________________________________________________________________________
(Address)
1. ______________________________________________________________________________________________________________
(Name)(Phone #)
_____________________________________________________________________________________________________________
(Address)
EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any
Employment experience must cover 10 years. If you need additional space, please continue on a separate sheet of paper.
Employer |
Employed |
|
Hourly Rate/Salary |
_________________________________________________ |
from ____/____ to ____/____ |
Starting_______ Ending______ |
|
Address |
|
Your Job Title |
|
________________________________________________________________ |
_____________________________________________ |
||
Telephone Number |
|
Supervisor’s Name |
|
________________________________________________________________ |
_____________________________________________ |
||
Reason For Leaving |
|
|
|
_________________________________________________________________________________________________________________
Work Performed
_________________________________________________________________________________________________________________
Employer |
Employed |
|
Hourly Rate/Salary |
_________________________________________________ |
from ____/____ to ____/____ |
Starting_______ Ending______ |
|
Address |
|
Your Job Title |
|
________________________________________________________________ |
_____________________________________________ |
||
Telephone Number |
|
Supervisor’s Name |
|
________________________________________________________________ |
_____________________________________________ |
||
Reason For Leaving |
|
|
|
_________________________________________________________________________________________________________________
Work Performed
_________________________________________________________________________________________________________________
Employer |
Employed |
|
Hourly Rate/Salary |
_________________________________________________ |
from ____/____ to ____/____ |
Starting_______ Ending______ |
|
Address |
|
Your Job Title |
|
________________________________________________________________ |
_____________________________________________ |
||
Telephone Number |
|
Supervisor’s Name |
|
________________________________________________________________ |
_____________________________________________ |
||
Reason For Leaving |
|
|
|
_________________________________________________________________________________________________________________
Work Performed
_________________________________________________________________________________________________________________
Employer |
Employed |
|
Hourly Rate/Salary |
_________________________________________________ |
from ____/____ to ____/____ |
Starting_______ Ending______ |
|
Address |
|
Your Job Title |
|
________________________________________________________________ |
_____________________________________________ |
||
Telephone Number |
|
Supervisor’s Name |
|
________________________________________________________________ |
_____________________________________________ |
||
Reason For Leaving |
|
|
|
_________________________________________________________________________________________________________________
Work Performed
_________________________________________________________________________________________________________________
STATEMENT AND CONSENT
In compliance with the Privacy Act of 1974, the following information is provided:
Solicitation of the information contained within this application is authorized by 25 U.S.C. 2701 et.seq. The purpose of the requested in-
formation is to determine the eligibility of individuals to be employed in a gaming operation. The information will be used by The National Indian Gaming Commission members and staff who have need for the information in the performance of their oficial duties. The informa-
tion may be disclosed to appropriate Federal, Tribal, State, Local or Foreign Law Enforcement and Regulatory Agencies when relevant
to civil, criminal or regulatory investigations or prosecutions or when pursuant to a requirement by a tribe or The National Indian Gaming Commission in connection with the hiring or iring of an employee, the issuance or revocation of a gaming license or investigations of
activities while associated with a tribal or gaming operation. Failure to consent to the disclosures indicated in this notice will result in the tribe’s being unable to hire you in any position. _____Initial
A false statement on any part of your application may be grounds for not hiring you, or for iring you after you begin work. Also, you may be punished by ine or imprisonment (US Code, Title 18, Section 1001). _____Initial
Due to the nature of our business, you will be subject to an extensive background investigation including criminal history. Therefore, as a part of this application, you hereby authorize the CICC and its agents to investigate your references, and to make an independent investiga-
tion of your character, conduct, credit, education, employment and criminal records including the Federal Bureau of Investigation and/or any other clearance agencies and give the right to access any and all of your iles and/or records maintained by these agencies
___________________________ Signature
I hereby release all persons from liability as a result of such disclosure. ______________________________________ Signature
I hereby authorize and give my consent to be given a drug and/or alcohol test at any time the Tribal Authorities deem necessary. I agree to be tested by the doctor or lab appointed by the CICC and I further authorize the test results to be disseminated to the Tribal Council and/ or its agents for administrative use as they deem necessary. ____________________________________ Signature
I hereby authorize all persons who may have information relevant to this application or background investigation to disclose said informa- tion to the CICC and its agents. ____Initial
I understand that failure to reveal any prior employer, or the giving of false or misleading information, or the omission of any requested information on this application will be grounds for Colusa Indian Community Council (CICC) not hiring me or will justify termination of my employment. ____Initial
All employees are “employees at will”. There is no employment contract implied or expressed between any employee and the CICC.
____Initial
I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION
Signature: ________________________________________________________________________________ Date: __________________
Print Name: ______________________________________________________________________________________________________
(Last) |
(First) |
(Middle Initial) |
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CICC Human Resources Department |
Rev. 6/2011 |
CCR Human Resources Department |
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