Fillable W12180 County Road A Bowler, WI 54416

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W12180 County Road A Bowler, WI 54416

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W12180 County Road A
Bowler, WI 54416
Phone: (715) 787-3110 Fax: (715) 787-4113
APPLICATION FOR EMPLOYMENT
NOTICE: Applicant should read carefully before completing application. Please print or type all information (use
black or blue ink). Applicant must complete all four (4) pages. Application must be completed in full.
Full Name (first, middle, last)
Current Mailing Address
Home Phone Cell Phone
Email
U.S. Citizen: Yes No Date of Birth is required on page 3. Must be 18 years of age.
Are you a veteran? Yes No If yes, what branch of service?
Position(s) applying for:
Salary desired: Hourly Annually Date available to start
Please indicate which types of employment you are applying for (check more than one if you wish):
Full Time Part Time Temporary
Are you willing to take a physical examination, health or tuberculosis screening at our expense? Yes No
Are you currently employed? Yes No If yes, may we contact your current employer? Yes No
List professional, business or civic activities and offices held
Do you have a valid driver’s license? Yes No Driver’s license #
How did you hear about us? Website: Community Posting
Billboard Radio Employee: Other
Do you have any impairment (physical, mental, medical) that would interfere with your ability to perform all the duties of
the job that you are applying for? Yes No If yes, please describe impairment and explain work limitations.
FOR HUMAN RESOURCE OFFICE USE ONLY
Date CIB Completed Date Received
CIB Eligibility: No Record Eligible Pending Not Eligible Permanent Bar
EDUCATION AND TRAINING SECTION
Do you have a High School Diploma or GED? Yes No Year of Graduation
Name and Location of High School
High School Diploma or GED is required if you are 19 years old and under. Please provide a copy with your application.
List any training beyond high school (college/university/vocational/specialized).
Name and Location of School Years Attended Degree Earned Course of Study
EMPLOYMENT HISTORY
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military
experience. Explain any gaps in employment in comment section below. All applications for technical, supervisory
and managerial positions must include a resume to be considered.
Employer Address
Telephone Dates Employed Job Title
Starting Rate of Pay Final Rate of Pay
Supervisor Reason for Leaving
Job duties
Employer Address
Telephone Dates Employed Job Title
Starting Rate of Pay Final Rate of Pay
Supervisor Reason for Leaving
Job duties
Employer Address
Telephone Dates Employed Job Title
Starting Rate of Pay Final Rate of Pay
Supervisor Reason for Leaving
Job duties
Employer Address
Telephone Dates Employed Job Title
Starting Rate of Pay Final Rate of Pay
Supervisor Reason for Leaving
Job duties
Describe any special skills and qualifications that may qualify you to work for North Star Mohican Casino Resort.
Comments about previous work experience
BACKGROUND INFORMATION SECTION
In accordance with Section IV G Mohican Gaming Enterprise, Personnel Policies and Procedures, the following
criteria must be met to be eligible as an employee of North Star Mohican Casino Resort.
All current employees and new applicants who seek employment with North Star Mohican Casino Resort shall
not have been convicted or entered a plea of guilty or no contest to any offense that may result in a bar to obtaining or
retaining a gaming license, or any other activity that would injure or pose a threat to the public interest, the integrity of the
gaming facility or the effective regulation thereof, or enhance the dangers of unfair, unsuitable or illegal gaming practices.
To ensure that these criteria are evaluated before appointments are made, all applicants must complete this
application and agree to a background check. Any information contained on the application is strictly confidential, except
that it is subject to the Privacy Notice, as printed in this application.
Full Name (first, middle, last)
Current Mailing Address
Current Phone Number Social Security # (required)
Previous Names Used
Date of Birth (required) Place of Birth Sex: M F
Race: Indian White Black Hispanic Asian Other U.S. Citizen: Yes No
Have you ever been convicted of a felony, misdemeanor or ordinance violation? Yes No If yes, please provide
details as date, type of offense, location, etc.
Do you have pending court charges for a felony, misdemeanor or ordinance violation? Yes No If yes, please
provide details as date, type of offense, location, etc.
TRIBAL PREFERENCE INFORMATION
THE FOLLOWING INFORMATION IS SOLICITED IN ORDER TO MEET THE REQUIREMENTS
OF THE MOHICAN NATION EMPLOYMENT PREFERENCE ORDINANCE
1. Are you an enrolled member of the Stockbridge-Munsee Tribe? Yes No
What is your enrollment number? #
2. Are you a direct descendant of the Stockbridge-Munsee Tribe? Yes No
What is the name and enrollment number of your biological parent?
3. Are you a legal spouse of an enrolled member of the Stockbridge-Munsee Tribe? Yes No
What is the name and enrollment number of your spouse?
FOR HUMAN RESOURCE OFFICE USE ONLY
(North Star Mohican Casino Resort needs to see and verify your enrollment, please provide your card)
Verified By: Date
Document or Source
DRUG TESTING ACKNOWLEDGEMENT
I understand that North Star Mohican Casino Resort has a commitment to maintain a drug-free workplace and requires a
drug screening as a part of its selection and hiring process. I understand that such drug screening will consist of the
testing of a urine sample or other medically recognized test designed to detect traceable amounts of a controlled substance
in my body. If after a confirmed test, it is determined my specimen contains a controlled substance or was adultered or
substituted, I will be disqualified from consideration for employment and any offer of employment will be withdrawn. I
further understand that if I am employed, I may be randomly selected for screening and under certain circumstances, may
be required to submit to testing for reasonable suspicion, accident or unsafe practices or follow-up. I understand that a
confirmed positive result of that testing or refusal to submit to testing may result in disciplinary action, including
dismissal from employment. I have read, understand and agree to this statement.
PRIVACY NOTICE
In compliance with the Privacy Act of 1974, the following information is provided: Solicitation of the information on this
form is authorized by 25 USC 2701 ET seq. The purpose of the requested information is to determine the eligibility of
individuals to be employed in a gaming operation. The information will be used by National Indian Gaming Commission
members and staff who have need for the information in the performance of their official duties. The information 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. The information may be disclosed when pursuant to a
requirement by a tribe or the National Indian Gaming commission in connection with the hiring or firing of an employee,
the issuance or revocation of a gaming license or investigations of activities while associated with a tribe or a gaming
operation. Failure to consent to the disclosures indicated in this notice will result in North Star Mohican Casino Resort
being unable to hire you in a primary management official or key employee position. The disclosure of your social
security number is voluntary; however, failure to supply this information may result in errors processing your application.
NOTICE REGARDING FALSE STATEMENTS
A false or dishonest answer to any question on this application will be grounds for rating an applicant ineligible for
employment with North Star Mohican Casino Resort or for dismissal after employment. All statements on this
application are subject to inquiry.
NON-DISCLOSURE NOTICE
I agree not to divulge any records, customer lists, methods, practices or procedures with which North Star Mohican
Casino Resort conducts its business, as this is propriety information that is protected as trade secrets. I agree that all such
matters and information shall be kept strictly confidential at all times during my employment and thereafter.
CONSENT TO RELEASE INFORMATION
I hereby authorize all parties named in this application to disclose to North Star Mohican Casino Resort Human Resource
Office any information necessary to determine eligibility for employment, including information regarding my service,
character and conduct. I hereby release the parties from all liability that may arise from furnishing such information. This
authorization is good throughout the duration of the individual’s employment and expires upon employment separation.
Employment applications are kept on file 120 days from the time the application is received.
All information in this employment application are true and accurate to be the best of my knowledge and I agree to the
terms set forth.
Applicant Signature Date
Updated 2/25/2019
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W12180 County Road A Bowler, WI 54416

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Completed 27 January 2021

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