APPLICATION FOR GAMING COMMISSIONER

Kaw Nation Careers

Gaming Commissioner Position

Prefix

First Name *

Middle Name *

Last Name *

Birth Date *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Phone *

Email Address

Social Security Number *0 / 12

ARE YOU KNOWN TO FORMER EMPLOYERS/REFERENCES BY ANOTHER NAME? *

YESNO

IF YES, WHAT NAME?

ARE YOU LEGALLY ENTITLED TO WORK IN THE UNITED STATES? *

YESNO

DO YOU HAVE A VALID DRIVER LICENSE? *

YESNO

License Number

State

Type

HAS YOUR LICENSE BEEN SUSPENDED WITHIN THE PAST 3 YEARS? *

YESNO

HAVE YOU EVER BEEN EMPLOYED BY KAW NATION? *

YESNO

IF YES, PROVIDE DATES OF EMPLOYMENT AND POSITION HELD.

DO YOU HAVE RELATIVES CURRENTLY EMPLOYED BY KAW NATION? *

YESNO

IF YES, PROVIDE RELATIONSHIP AND POSITION

ARE YOU AN ENROLLED MEMBER OF A FEDERALLY RECOGNIZED INDIAN TRIBE? *

YESNO

IF YES, WHAT TRIBE?

IF YES, PROVIDE A COPY OF YOUR CERTIFICATE/TRIBAL ID WITH THIS APPLICATION.

No file chosen

HAVE YOU EVER SERVED IN THE U.S. MILITARY/NATIONAL GUARD? *

YESNO

IF YOU ARE A VETERAN, DID YOU RECIEVE ANY TRAINING WHICH WOULD BE HELPFUL IN THE JOB FOR WHICH YOU ARE APPLYING? *

YESNO

IF YES, DESCRIBE:

HOW DID YOU FIND OUT ABOUT THIS JOB OPENING?

RadioSocial MediaNewspaperWord of Mouth

Education

DO YOU POSSESS A HIGH SCHOOL DIPLOMA? *

YesNo

CAN YOU PROVIDE A COPY OF YOUR DIPLOMA OR GED? *

YesNo

YOUR NAME AS IT IS LISTED ON YOUR DIPLOMA

HIGH SCHOOL NAME

HIGH SCHOOL LOCATION

1.) COLLEGE/UNIVERSITY ATTENDED

COLLEGE/UNIVERSITY LOCATION

Years Completed

COURSE OF STUDY

2.) COLLEGE/UNIVERSITY ATTENDED

COLLEGE/UNIVERSITY LOCATION

Years Completed

COURSE OF STUDY

3.) COLLEGE/UNIVERSITY ATTENDED

COLLEGE/UNIVERSITY LOCATION

Years Completed

COLLEGE/UNIVERSITY LOCATION

EMPLOYMENT HISTORY

Begin with your most recent employment and work backward. Include all jobs/positions held during the past ten years or periods of unemployment over 90 days. You may include jobs held more than ten years ago if relevant to position you are seeking. (Please fill out, do not state “see resume”).

A.) EMPLOYER

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

POSITION

PART TIMEFULL TIME

DUTIES

MONTHLY INCOME UPON START OF EMPLOYMENT

USD

MONTHLY INCOME ON LAST DATE OF EMPLOYMENT

USD

MAY WE CONTACT?

YESNO

SUPERVISOR

PHONE NUMBER

REASON FOR LEAVING

B.) EMPLOYER

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

POSITION

PART TIMEFULL TIME

DUTIES

MONTHLY INCOME UPON START OF EMPLOYMENT

USD

MONTHLY INCOME ON LAST DATE OF EMPLOYMENT

USD

MAY WE CONTACT?

YESNO

SUPERVISOR

PHONE NUMBER

REASON FOR LEAVING

C.) EMPLOYER

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

POSITION

PART TIMEFULL TIME

DUTIES

MONTHLY INCOME UPON START OF EMPLOYMENT

USD

MONTHLY INCOME ON LAST DATE OF EMPLOYMENT

USD

MAY WE CONTACT?

YESNO

SUPERVISOR

PHONE NUMBER

REASON FOR LEAVING

D.) EMPLOYER

START DATE

Month

Day

Year

END DATE (put current date if still employed)

Month

Day

Year

EMPLOYER ADDRESS

City

State/Province

ZIP / Postal Code

POSITION

PART TIMEFULL TIME

DUTIES

MONTHLY INCOME UPON START OF EMPLOYMENT

USD

MONTHLY INCOME ON LAST DATE OF EMPLOYMENT

USD

MAY WE CONTACT?

YESNO

SUPERVISOR

PHONE NUMBER

REASON FOR LEAVING

REFERENCES

Provide three references capable of commenting on your ability to perform the work for which you have applied. Applicants should include references from their previous places of employment. Telephone numbers and addresses for reference contacts must be provided.

REFERENCE #1 *

TITLE *

COMPANY *

Phone *

REFERENCE'S ADDRESS *

REFERENCE #2 *

TITLE *

COMPANY *

Phone *

REFERENCE'S ADDRESS *

REFERENCE #3 *

TITLE *

COMPANY *

Phone *

REFERENCE'S ADDRESS *

Kaw Nation adopts the provisions of the Indian Self Determination & Education Assistance Act PL 93-638 as amended. In selection for employment, preference will be given to enrolled members of federally recognized Nations, providing other qualifying factors prove the enrolled member equal in merit to other applicants. I certify answers given on this application are true and complete to the best of my knowledge. In the event of employment, I understand false or misleading information given in my application or interview(s) may result in termination of employment regardless of length of employment, or cancellation of the job offer without notice. I understand I am required to abide by all rules, regulations, and laws of Kaw Nation. I understand if I am employed by Kaw Nation in a position where I will be driving a Kaw Nation vehicle on a regular basis; any offer of employment I receive will be contingent on Kaw Nation verifying I have an acceptable driving record and a valid Driver's License. I authorize the Kaw Nation or its designated representative(s) to obtain information regarding my driving record in any state at any time while I am employed by (or seeking employment with) Kaw Nation. In the event my MVR indicates I am a High Risk Driver as defined in the glossary of the Fleet Safety Program, I understand I may be subject to dismissal. The applicant does hereby authorize the Kaw Nation to seek employment verification, information, or records from all former and current employers listed on this application. I hereby give my permission to Kaw Nation to investigate all statements given in this application or during interview(s), and I release from liability any person, company, agency, or corporation collecting or supplying such information to Kaw Nation and its employees. I further understand offers of employment are contingent upon passing a criminal background check, and in some designated positions accreditation through the Bureau of Indian Affairs (BIA). I further understand I will be required to pass a post offer of employment drug screen and/or medical review. I understand acceptance of an offer of employment does not create a contractual obligation upon Kaw Nation to continue to employee me in the future. I acknowledge the Kaw Nation is an “at-will” employer. I have read and understand the above statements: (Provide signature below) *

DATE *

STATE LAW NOTICES AND DISCLOSURES - BACKGROUND INVESTIGATION Pursuant to state law, the following disclosures are provided to the state residents.

CALIFORNIA applicants or employees only: By signing below, you acknowledge receipt of the NOTICE – BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. NEW YORK applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting American Checked Inc, 4870 S. Lewis, Ste. 120, Tulsa OK 74105; Phone: 1-800-975-9876. NEW YORK applicants or employees only: By signing below, you acknowledge receipt of a copy of Article 23-A of the New York Correction Law. WASHINGTON applicants or employees only: You have the right to request form American Checked Inc a written summary of you rights and remedies under the Washington Fari Credit Reporting Act. *

DATE *

PRINTED NAME *

NOTICE - BACKGROUND INVESTIGATION

CALIFORNIA, MASSACHUSETTS, MINNESOTA and OKLAHOMA applicants or employees only: Please check the box if you would like to receive a copy of your consumer report, free of charge, if one is obtained by the Company.

CALIFORNIAMASSACHUSETTSMINNESOTAOKLAHOMA

ADDITIONAL INFORMATION (INTERNAL USE ONLY)

In connection with my application for employment, I direct the following regarding my current employer. *

Yes, my current employer may be contacted.No, my current employer may not be contacted.

I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights *

In connection with my application for employment, I direct the following regarding my current employer. I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights I authorize Company and Agency to use email communication with me to provide me with notices and information regarding any report or use of such report. If I do not have an email address or do not wish to share it, then communication will be by U.S. Mail, which will result in slower communication. *

DATE

In connection with your employment/ licensure (including contract or volunteer services) or application to rent a dwelling with Kaw Nation, notice is hereby given that a consumer report may be obtained from a consumer reporting agency for employment purposes. These reports may contain information about your character, general reputation, persona characteristics and mode of living, whichever are applicable. They may involve personal interviews with sources such as your neighbors, friends or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and /or motor vehicle records, education or employment history, or other background checks. You have the right, upon written request made within a reasonable time after the receipt of the notice, to request disclosure of the nature and scope of any investigative consumer report prepared by contacting the Company and AmericanChecked, 4870 South Lewis Ave., Suite 120, Tulsa, OK. 74105; Phone: 1-800-975-9876. For information about AmericanChekcked privacy practices, see http://americanchecked.com/privacy-policy. The scope of this notice and below authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow the Company to conducts future screening for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing. By signing below, I hereby authorize the obtaining of consumer reports and/or investigative consumer reports b the Company at any time after receipt of this authorization and throughout the course of my employment, if applicable. *

DATE

PLEASE ATTACH RESUME *