DEAR APPLICANT: This questionnaire has been prepared in compliance with the Privacy Act of 1974. Solicitation of the information on this form is authorized by 25 United States code, Section 2701 et seq. The purpose is to determine the eligibility of individuals to be employed by a gaming facility. Members of the National Indian Gaming Commission and staff may review this information. Some portions may be disclosed to appropriate federal, tribal, state, local, or foreign law enforcement and regulatory agencies when relevant to a civil, criminal or regulatory investigation or prosecution. Various data may be required by management, the Tribal Gaming Commission or the National Indian Gaming Commission in connection with the hiring and firing of an employee, the issuance or revocation of a gaming license, or investigations of activities while the applicant was associated with a tribe or gaming operation. Failure to answer any questions on this form may result in the tribe being unable to hire you as a casino employee. A false statement or omission of material fact on any part of this application may be grounds for not hiring you or for discharging you after you commence employment. Furthermore, you may be subject to fines and/or imprisonment. (Title 18, Untied States code, Section 1001). The disclosure of your Social Security Number (SSN) is voluntary. However, your failure to supply a SSN may result in errors in processing your application.

Personal infromation

Position(s) Applied For

Criminal History

Aconviction will not necessarily disqualify an applicant from employment and will only be considered in relation to specific job requirements