Criteria for Gaming License Disqualification
Absolutely no felonies within the past ten (10) years.
THEFT/FRAUD within two (2) years AUTOMATIC DISQUALIFICATION
DOMESTIC ABUSE/ASSAULT AND BATTERY within two (2) years AUTOMATIC DISQUALIFICATION (Unless
applicant can provide proof that he/she has attended a treatment program)
DRUG/ALCOHOL RELATED OFFENSES within two (2) years AUTOMATIC DISQUALIFICATION (Unless applicant can
provide proof that he/she has attended a treatment program)
Please provide your residence information for the past five (5) years. Start with your present residence.
Add Another Residence
Please provide employment information for the past five (5) years. Start with your present or last job, including military service, assignment and volunteer activities. You may exclude organization names which indicate race, color, gender, national origin, handicap or other protected status.
Add at least your last 3 Employment Positions by clicking the button below to add the record.
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Special Skills and qualifications
Professional Affiliation or Membership:
Typing, Computer or Office Skills:
City, ST, Zip
Trade, Business, Other School
City, ST, Zip
City, ST, Zip
Describe any specialized
Training, Apprentice Skills, or
Describe any honors or
certificates that you have
State information you feel may
be helpful to us while
considering your application
List three references not related to you
City, State, Zip
City, State, Zip
City, State, Zip
Verification of Indian Preference
Enrolled Cheyenne and Arapaho Tribal Member
Enrolled Member of Another Tribe
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INDIAN PREFERENCE: It is the policy of Lucky Star Casino to give preference in employment to
qualified, enrolled members of the Cheyenne and Arapaho Tribes and secondly, to qualified members
of other Indian Tribes or Native American Groups. Third preference will be given to all other qualified
Two forms of I.D (including one picture I.D.) is required to complete this application. Acceptable forms of
I.D. include a valid Driver’s License, Certified Degree of Indian Blood (CDIB), State I.D., Voter
Registration card, Social Security card or Birth Certificate. A tribal enrollment card or certified degree
of Indian blood (CDIB) card is needed to apply to verify eligibility of Indian Preference
False information given or implied on an application form is grounds for immediate dismissal, without further notice.
I authorize this company to make an investigation of all information contained in this application for employment, and I release from all liability all companies and corporations suppling such information. I understand that any false answers, statements or implications made by me on this application or other required documents shall be considered sufficient cause for denial or employment or discharge. Upon terminiation of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I hearby agree to submit to such physical examinations as may be required and any drug test(s) that may be requested of me, whether prior to my employment or, if employed by this company, at any time thereafter. During such employment, I understand and agree that in the
event that I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition I hereby authorize the limited release and exchange of medical information relating to my condition between the treatment provider and a company designated physician. I further understand that this is an application for employment and that no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and that the company can change my schedule or conditions at any time. I have read and understand the above.
By my signature below, I promise that the information provided in this employment application (and in any
related documentation and or interview) is true and complete, and I understand that any false or misleading
information or significant omissions may result in dismissal from employment, if discovered at a later date.
I agree to immediately notify the casino of my employment if I should be convicted or plead guilty to any
crime while my job application is pending, or during my period of employment, if hired.
I authorize any person, school, current employer (except as previously noted), past employers, and
organizations named in this application form (or related documentation or interview) to provide the casino
with any information and opinion requested by legal liability and making such statements.
I understand that this application does not create a contract of employment. I understand that if hired, I am
obliged to comply with any and all current and subsequently adopted casino policies. I understand and
agree that, if hired, my employment is for no definite period of time, and may, regardless of date or
payment of wages or salary, be terminated at any time, for any reason, and with or without cause, notice or
prior discipline. I understand that no person is authorized to change any of the terms mentioned in this employment application.
CONSENT FOR DRUG/ALCOHOL SCREENING
IF YOU ARE OFFERED AND ACCEPT EMPLOYMENT WITH THE CASINOS, YOU WILL BE
REQUIRED TO TAKE A URINE TEST FOR DRUG/ALCOHOL USE AS A CONDITION OF
EMPLOYMENT. THE CASINOS ALSO REQUIRE INDIVIDUALS TO SUBMIT TO RANDOM
TESTING THROUGHOUT THEIR EMPLOYMENT. THE PURPOSE OF DRUG AND ALCOHOL
TESTING IS TO ENSURE A DRUG-FREE WORKING ENVIRONMENT.
I have been fully informed by my potential employer of the reason for this
urine test for drugs and alcohol. I understand what I am being tested for, the procedure involved, and I
freely give my consent. I also understand that the results of this test will be sent to my prospective
employer and will become part of my record.
If this test is positive and for this reason I am not hired, I understand that I will be given the opportunity to
explain the reasons for the results of this test.
I authorize these test results to be released. Please Initial
PRIVACY NOTICE TO APPLICANT
In compliance with the Privacy Act of 1974, the following information is provided:
Solicitation of the information on this form is authorized by 25 U.S.C. 2701 et seq. The purpose of the
requested information is to determine the eligibility of individuals to be employed in a gaming operation.
This information will be used by the casino members and staff who need 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 or 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 of 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 the Tribes’ being unable to hire
you in a primary management or key employee position.
The disclosure of your Social Security Number (SSN) is voluntary, however, failure to supply a SSN may
result in errors in processing your application.
NOTICE REGARDING FALSE STATEMENTS
A false statement on any part of this application may be grounds for not hiring you, or for firing you after
you begin work. False statement may also be punished by fine or imprisonment (U.S. Code, Title 18,