Application For Employment

WINNAVEGAS CASINO
1500 330th Street
SLOAN, IA 51055

DEAR APPLICANT: This questionnaire has been prepared in compliance with the Privacy Act of 1974. Solicitation of the information on this form is authorized by 25 United States code, Section 2701 et seq. The purpose is to determine the eligibility of individuals to be employed by a gaming facility. Members of the National Indian Gaming Commission and staff may review this information. Some portions may be disclosed to appropriate federal, tribal, state, local, or foreign law enforcement and regulatory agencies when relevant to a civil, criminal or regulatory investigation or prosecution. Various data may be required by management, the Tribal Gaming Commission or the National Indian Gaming Commission in connection with the hiring and firing of an employee, the issuance or revocation of a gaming license, or investigations of activities while the applicant was associated with a tribe or gaming operation. Failure to answer any questions on this form may result in the tribe being unable to hire you as a casino employee. A false statement or omission of material fact on any part of this application may be grounds for not hiring you or for discharging you after you commence employment. Furthermore, you may be subject to fines and/or imprisonment. (Title 18, United States code, Section 1001). The disclosure of your Social Security Number (SSN) is voluntary. However, your failure to supply a SSN may result in errors in processing your application.

PERSONAL INFORMATION

Please fill-in each line completely - Type or print - Use ink

##########
#########
List up to three position for which you would like to be considered
You will be required to show proof of enrollment in a federally recognized tribe

CRIMINAL HISTORY

*A conviction will not necessarily disqualify an applicant from employment and will only be considered in relation to specific job requirements*

EDUCATION

Please be prepared to show proof of education

CIVIC

OFFICE SKILLS

Check all that apply

SPECIAL SKILLS

REFERENCES

Please list three references that we may contact - Do not include relatives

EMPLOYMENT HISTORY

Give only accurate and complete information about any and all employment. Start with your current or most recent employer and go back. Be sure to list all phone numbers for verification.

APPLICANT AGREEMENT

It is understood that if I am employed by WinnaVegas, I agree to the following conditions:

I understand that my employment is not guaranteed for any term and that either WinnaVegas or I can terminate my employment at any time.

I understand that if employed, I will be subject to a 90-day probationary period, which can, at the employer's discretion, be extended.

I understand that WinnaVegas maintains a Drug and Alcohol Free Workplace environment and that I will be required to sign a statment indicating that I will abide by these terms as a condition of my employment.

I give my consent for WinnaVegas to verify my employment, educational, and character background by contacting any previous employers, educational facilities, and/or personal references I have listed.

I certify that all the answers contained herein are true. I further understand that omission of facts or misrepresentation of any facts requested is cause for dismissal.

mm/dd/yy