Safety Officer

The Lucky Star and Feather Warrior Casinos are Equal Opportunity Employers and will not discriminate against an applicant or employee on any grounds protected under federal, state, or local law including race, color, creed, religion, age, sex, national origin, ancestry, marital status regarding public assistance, membership or non-membership in any legal organization, or any other characteristic protected under federal, state, or local law. None of the questions in this application are intended to elicit information regarding any protected characteristic, nor imply any limitation, illegal preference, or discrimination based upon non-job related information or protected characteristics.

If you are hired by the casino(s) you will be employed on an at-will basis. As an at-will employee, you may terminate your employment at any time, for any reason and with or without prior notice, cause or discipline. No casino supervisor or manager has the authority to offer or promise anything other than at-will employment.

Personal

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Position Applied For(Required)

Are you 18 years of age or older?(Required)

Yes

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or Immigration status will be required upon employment)(Required)

Yes

Are you able to work: (Please mark all that apply)

Full Time

Part Time

On Call

Day Shift

Date Available for Work(Required)

Have you previously been employed with Lucky Star Casinos?(Required)

Yes

Have you been convicted of a felony within the past 10 years?(Required)

Yes

If yes state the nature of the offense and disposition of the case. Include dates and places.

Note: Felony charges or the existence of a criminal record does not constitute an automatic bar to employment:

Are you currently banned from any Lucky Star Casino location?(Required)

Yes

Have you ever been banned from any Lucky Star Casino property?(Required)

Yes

If yes, list year and location

Criteria for Gaming License Disqualification

Felonies

Absolutely no felonies within the past ten (10) years.

Misdemeanors

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)

Residential History

Please provide your residence information for the past five (5) years. Start with your present residence.

Most Recent First

Residence

Address	Landlord Name	Landlord Phone Number	Date From	Date To	Actions

There are no Residences.

Employment History

Please provide employment information for the past five (5) years. Start with your present or last job, include military service, assignments and volunteer activities. You may exclude organization names which indicate race, color, gender, national origin, handicap or other protected status. You may attach additional papers if necessary.

Employment

Employer Name	Employer Phone Number	Address	Supervisor (Name and Title)	Position Title	Pay Rate	Date From	Date To	Description of Duties	Reason for Leaving	Actions

There are no Employments.

Military Service

Branch

Rank

Description of Military Duties

Present Membership (i.e. National Guard, Reserves, etc.)

Special Skills and Qualifications

Licenses

Professional Affiliation or Membership

Certifications

Languages

Typing, Computer or Office Skills

Education

High School

Year Graduated

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Trade, Business, Other

Year Graduated

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Major(s)

Minor(s)

Degree(s)

Describe any specialized Training, Apprentice Skills, or Extra-Curricular Activities.

Describe any honors or certificates that you have received.

State information you feel may be helpful to us while considering your application.

References

List three references not related to you.

Name(Required)

First Last

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name(Required)

First Last

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name(Required)

First Last

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Verification of Indian Preference

Are you an Enrolled Cheyenne and Arapaho Tribal Member? Enrollment Number:

Are you a spouse of an Enrolled Cheyenne and Arapaho Tribal Member? Spouse’s Name and Enrollment Number:

Are you an Enrolled Member of Another Tribe? Enrollment Number:

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 applicants.

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.

Applicant Statement

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.

Signature(Required)

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.

Signature(Required)

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 U.S.C. 2701 et seq. The purpose of the requested information is to determine the eligibility of individuals to be granted a gaming license. The information will be used by the Tribal gaming regulatory authorities and by the National Indian Gaming Commission (NIGC) members and staff who have need for the information in the performance of their official duties. The information may be disclosed by the Tribe or the NIGC 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 NIGC in connection with the issuance, denial 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 a tribe’s being unable to license you for a primary management official 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 denying a license or the suspension or revocation of a license. Also, you may be punished by fine or imprisonment (U.S. Code, Title 18, Section 1001).

Signature(Required)

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Name

This field is for validation purposes and should be left unchanged.

Full Time | Concho

Personal

Criteria for Gaming License Disqualification

Felonies

Misdemeanors

Residential History

Most Recent First

Employment History

Military Service

Special Skills and Qualifications

Education

References

Verification of Indian Preference

Applicant Statement

Consent for drug/alcohol screening

Privacy Notice