Employment

If yes, what branch?

If yes, date entered: Date Discharged:

If yes, please describe any special skills or training acquired while in the service:

Work Performed (please include position(s) held)

Reason for Leaving

Employer
(Full name, address, & phone number)

Employment
Dates
From - To

Position/Title

Supervisor

Work Performed (please include position(s) held)

Reason for Leaving

Employer
(Full name, address, & phone number)

Employment
Dates
From - To

Position/Title

Supervisor

Work Performed

Reason for Leaving

Employer
(Full name, address, & phone number)

Employment
Dates
From - To

Position/Title

Supervisor

Work Performed

Reason for Leaving

Today's Date:	09/21/2017

Position applying for:
1:	*
2:
3:
4:

Last Name:	*
First Name:	*
Middle Name:
Address:	*
City:	*
State:	*
Zip:	*
Home Phone:	*
Cell Phone:

The minimum age for employment is 18. Some positions require employees to be 21 years of age.
Are you at least 18 years of age:	Yes No *
Are you at least 21 years of age:	Yes No *

Have you ever been employed here before:	Yes No *
If yes, give date:
If yes, may we contact your employer?	Yes No *
Are you a United States citizen?	Yes No *
If no, do you have a valid work permit?	Yes No
Proof of citizenship or immigration status may be required upon employment.

Employment desired:	Full Time Part Time *
When are you available for work?	*
Are you on a lay-off or subject to recall?	Yes No

Background Information
Within the past 5 years have you been convicted of a misdemeanor involving fraud, misrepresentation, gambling or theft?
Yes No *
If yes, please explain:
Have you ever been convicted of a felony? Yes No *
If yes, please explain:
Are you an enrolled member of a Native American or an Alaska Nation Tribe? Yes No *
If so, what Tribe? *

Education
Schools Attended (Names and Addresses)	Number of years completed	Received Diploma (Degree or Certificate)
High School:		Yes No GED

College:		Yes No
Type of Degree:
Majored In/Minored In:

Graduate School:		Yes No

Bus. or Trade School:		Yes No

Professional School:		Yes No
Special Honors:
Computer Skills (only for positions which require computer skills) Check the computer skills with which you are proficient (any version) PC User MacIntosh User Windows Microsoft Word Microsoft Outlook Microsoft Excel Email Internet Other

Drivers License (only for positions which require driving)
Do you have a valid drivers license? Yes No *
Drivers License Number: *
Issuing State: *
License Type: Operator Commercial (CDL) *
Expiration Date: *
Have you had any accidents during the past 3 years? Yes No * If so, how many:
Have you had any moving violations during the past 3 years? Yes No * If so, how many:

References
Please list three references other than relatives or previous employers
Name:	*
Address:
Position:	*
Reference Company:	*
Reference Telephone:	*
Name:	*
Address:
Position:	*
Reference Company:	*
Reference Telephone:	*

Name:	*
Address:
Position:	*
Reference Company:	*
Reference Telephone:	*

Resume Simply cut and paste your current resume from your word processing program.


WAIVERS AND DISCLOSURES Please read each section carefully and sign where indicated.
AT-WILL EMPLOYMENT It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment of a promise of future benefits by this organization. I understand and agree that, if hired; my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representatives made by agents or representatives of this organization. CERTIFICATION OF TRUTH AND ACCURACY I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge. An applicant for employment with any gaming establishment on the Standing Rock Sioux Reservation is required by tribal, federal and state gaming laws to fully disclose information concerning his/her criminal history, including all felonies and, particularly, crimes involving theft and deception. Accordingly, NOTICE is hereby given that the failure to disclose all such information accurately on the application may result in denial or revocation of a gaming license as well as criminal prosecution. NOTIFICATION AND AUTHORIZATION TO REQUIRE A MEDICAL EXAMINATION I hereby certify that, if hired, I will disclose any limitations I have that may impact my ability to do the job. I understand that I may also be required to undergo a pre-employment or post-employment medical exam by GRC’s designated health practitioner. NOTIFICATION AND AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION I understand that I may be subject to a background check, and hereby authorize the Standing Rock Sioux Tribe Gaming commission and its agents or any agency of its choice, to investigate my background to determine any and all information of concern as to my record, whether same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information. Additionally, you are hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records and credit history through an investigative or credit agency or bureau of your choice. I authorize the release of this information by the appropriate agencies to the investigating service. This authorization, in original or copy form, shall be valid for this and for any future reports and updates that may be required. I understand that passing the background check is a condition of employment. A negative background check can be grounds for dismissal, even if an offer has been made to me and I have been hired.
Full Name: *
This application for employment will remain active for a period of three months. Ask the organization representative for details.
Non-Discrimination Policy: GRC is committed to the principle of equal opportunity in employment. GRC does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities. GRC shall give preference to qualified Native Americans and Alaska Natives in all aspects of recruitment and employment.

Book Your

Background Information

Education

Computer Skills (only for positions which require computer skills)

Drivers License

Military

Work Experience

References

Resume

Quick Links

Military
Are you a veteran of the United State military? Yes No *
If yes, what branch?
If yes, date entered: Date Discharged:
If yes, please describe any special skills or training acquired while in the service:

Work Experience
Please list your work experience beginning with your most recent job.

Employer * (Full name, address, & phone number)	Employment Dates* From - To	Position/Title*	Supervisor*

Work Performed (please include position(s) held)
Reason for Leaving
Employer (Full name, address, & phone number)	Employment Dates From - To	Position/Title	Supervisor
Work Performed (please include position(s) held)
Reason for Leaving
Employer (Full name, address, & phone number)	Employment Dates From - To	Position/Title	Supervisor

Work Performed
Reason for Leaving
Employer (Full name, address, & phone number)	Employment Dates From - To	Position/Title	Supervisor

Work Performed
Reason for Leaving