Monowind Employment Application Name First Middle Last Phone*Date Of Application* MM slash DD slash YYYY Social Security Number Have you ever used another name?* Yes No Present Address: (Street# - P.O. Box)* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you under 21 years of Age?* Yes No Position Desired* Salary Desired Is 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?* Yes No If yes, please explain:Are you available to work on weekends?* Yes No Are you available to work overtime, if necesary?* Yes No If hired would you have a reliable means of transportation to and from work?* Yes No Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?* Yes No If 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?* Yes No If so, when? MM slash DD slash YYYY Are you employed now?* Yes No If yes, may we inquire of your present employer?* Yes No Date you can start employment?* MM slash DD slash YYYY Can you submit verification of your eligibility to work in the United States?* Yes No Have 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.* Yes No If yes, state the nature of the crime(s), when and where convicted and disposition of the case(s):School - GraduateSchool - Graduate - Name & Location Of School School - Graduate - Course Of Study School - Graduate - No. Of Years Completed School - Graduate - Did You Graduate? Yes No School - Graduate - Degree Or Diploma School - CollegeSchool - College - Name & Location Of School School - College - Course Of Study School - College - No. Of Years Completed School - College - Did You Graduate? Yes No School - College - Degree Or Diploma School - BusinessSchool - Business - Name & Location Of School School - Business - Course Of Study School - Business - No. Of Years Completed School - Business - Did You Graduate? Yes No School - Business - Degree Or Diploma School - TradeSchool - Trade - Name & Location Of School School - Trade - Course Of Study School - Trade - No. Of Years Completed School - Trade - Did You Graduate? Yes No School - Trade - Degree Or Diploma School - TechnicalSchool - Technical - Name & Location Of School School - Technical - Course Of Study School - Technical - No. Of Years Completed School - Technical - Did You Graduate? Yes No School - Technical - Degree Or Diploma School - High SchoolSchool - High School - Name & Location Of School School - High School - Course Of Study School - High School - No. Of Years Completed School - High School - Did You Graduate? Yes No School - High School - Degree Or Diploma Do you have any other experience, training, qualifications or skills which you feel make you especially suited for this position?Name of license Issuing State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State License/certification number Have you obtained any special skills or abilities as the result of military service? Yes No If yes, describe:DATES OF EMPLOYMENTNAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 1FROM MM slash DD slash YYYY TO MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 1 LAST POSITION & SALARY 1 REASON FOR LEAVING 1 NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 2FROM MM slash DD slash YYYY TO MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 2 LAST POSITION & SALARY 2 REASON FOR LEAVING 2 NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 3FROM MM slash DD slash YYYY TO MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 3 LAST POSITION & SALARY 3 REASON FOR LEAVING 3 NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 4FROM MM slash DD slash YYYY TO MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 4 LAST POSITION & SALARY 4 REASON FOR LEAVING 4 NAME, ADDRESS & PHONE NO OF EMPLOYER/COMPANY 5FROM MM slash DD slash YYYY TO MM slash DD slash YYYY SUPERVISOR'S NAME & POSITION 5 LAST POSITION & SALARY 5 REASON FOR LEAVING 5 ReferencesList below three persons not related to you who have knowledge of your work performance within the last three years.Reference 1 Name Reference 1 Occupation Reference 1 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 1 PhoneReference 2 Name Reference 2 Occupation Reference 2 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2 PhoneReference 3 Name Reference 3 Occupation Reference 3 Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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)*
