Monowind Employment Application Name First Middle Last Phone*Date Of Application* Date Format: MM slash DD slash YYYY Social Security NumberHave you ever used another name?*YesNoPresent Address: (Street# - P.O. Box)* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you under 21 years of Age?*YesNoPosition Desired*Salary DesiredIs any additional information relative to a change of name, use of an assumed name, or a nickname necessary to enable a check on your work or education record?*YesNoIf yes, please explain:Are you available to work on weekends?*YesNoAre you available to work overtime, if necesary?*YesNoIf hired would you have a reliable means of transportation to and from work?*YesNoAre you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?*YesNoIf no, describe the functions that cannot be performed:Do you have any friends or relatives in our employment, if yes, state name:Do you have any friends or relatives in our employment, if yes, state relationship:Have you ever applied or worked for Mono Wind Casino before?*YesNoIf so, when? Date Format: MM slash DD slash YYYY Are you employed now?*YesNoIf yes, may we inquire of your present employer?*YesNoDate you can start employment?* Date Format: MM slash DD slash YYYY Can you submit verification of your eligibility to work in the United States?*YesNoHave you ever been convicted of a criminal offense (felony or serious misdemeanor)? NOTE: a conviction will not necessarily disqualify an applicant for employment. Each instance will be considered in relation to the position for which the application has applied for.*YesNoIf yes, state the nature of the crime(s), when and where convicted and disposition of the case(s):School - GraduateSchool - Graduate - Name & Location Of SchoolSchool - Graduate - Course Of StudySchool - Graduate - No. Of Years CompletedSchool - Graduate - Did You Graduate?YesNoSchool - Graduate - Degree Or DiplomaSchool - CollegeSchool - College - Name & Location Of SchoolSchool - College - Course Of StudySchool - College - No. Of Years CompletedSchool - College - Did You Graduate?YesNoSchool - College - Degree Or DiplomaSchool - BusinessSchool - Business - Name & Location Of SchoolSchool - Business - Course Of StudySchool - Business - No. Of Years CompletedSchool - Business - Did You Graduate?YesNoSchool - Business - Degree Or DiplomaSchool - TradeSchool - Trade - Name & Location Of SchoolSchool - Trade - Course Of StudySchool - Trade - No. Of Years CompletedSchool - Trade - Did You Graduate?YesNoSchool - Trade - Degree Or DiplomaSchool - TechnicalSchool - Technical - Name & Location Of SchoolSchool - Technical - Course Of StudySchool - Technical - No. Of Years CompletedSchool - Technical - Did You Graduate?YesNoSchool - Technical - Degree Or DiplomaSchool - High SchoolSchool - High School - Name & Location Of SchoolSchool - High School - Course Of StudySchool - High School - No. Of Years CompletedSchool - High School - Did You Graduate?YesNoSchool - High School - Degree Or DiplomaDo you have any other experience, training, qualifications or skills which you feel make you especially suited for this position?Name of licenseIssuing State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State License/certification numberHave you obtained any special skills or abilities as the result of military service?YesNoIf yes, describe:DATES OF EMPLOYMENTNAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 1FROM Date Format: MM slash DD slash YYYY TO Date Format: MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 1LAST POSITION & SALARY 1REASON FOR LEAVING 1NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 2FROM Date Format: MM slash DD slash YYYY TO Date Format: MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 2LAST POSITION & SALARY 2REASON FOR LEAVING 2NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 3FROM Date Format: MM slash DD slash YYYY TO Date Format: MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 3LAST POSITION & SALARY 3REASON FOR LEAVING 3NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 4FROM Date Format: MM slash DD slash YYYY TO Date Format: MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 4LAST POSITION & SALARY 4REASON FOR LEAVING 4NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 5FROM Date Format: MM slash DD slash YYYY TO Date Format: MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 5LAST POSITION & SALARY 5REASON FOR LEAVING 5ReferencesList below three persons not related to you who have knowledge of your work performance within the last three years.Reference 1 NameReference 1 OccupationReference 1 Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 1 PhoneReference 2 NameReference 2 OccupationReference 2 Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2 PhoneReference 3 NameReference 3 OccupationReference 3 Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 3 PhonePlease read carefully, Initial each paragraph and sign below.I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if 1 am employed, regardless of the time elapsed before discovery.* Yes, I certify I hereby authorize Mono Wind Casino to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose the Casino any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Casino, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way realted to such investigation or disclosure.* Yes, I certify I understand and agree that employment is "AT WILL", meaning employment may be terminated by either myself or the Casino at any time, with or without cause, and with or without notice. I also understand and agree the Casino retains the right to demote, transfer, change my job duties, and my compensation at any time with or without notice and with or without cause In its sole discretion. Employer and Employee further understand and agree that other than the General Manager, no Manager, Supervisor or other representatfve of the Casino has authority to make any agreement, express or Implied, for employment for any specified period of time, orto make any agreement for employment other than at-will. The Casino and I also agree that this AT-WILL employment policy cannot be amended, modified or altered in any way by oral statements or in any other way, and can only be altered by written amendment signed by the General Manager of the Mono Wind Casino, indicating that it is intended as a modification of employee's AT-WILL status.* Yes, I certify Date (type date)*Signature (type name)*
