Name  Phone Number Social Security #

Tribal Member? yes no   If yes, Name of Tribe  Tribal Number

Present Address      City State Zip

Permanent Address City State Zip

E-Mail Address (required)

Have you ever used another name?  yes no

Are you under 18 years of age?         yes no     If yes, can you, if hired, submit a work permit? 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 able to work weekends?                                                                                                  yes no

Would you be available to work overtime, if necessary?                                                            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,           yes   no
either with or without reasonable accommodation?

If no, describe the functions that cannot be performed.

Do you have any friends or
relatives in our employment?         yes   no    If yes, state name and relationship.

Date you can start employment?

Have you ever applied or worked for this company before?  yes   no  If yes, where?

                                                                                                                                            when?

Can you, after hire, submit verification of your
eligibility to work in the United States?                   yes   no

Are you employed now?        yes   no

If yes, may we inquire of your present employer?    yes   no

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)?    yes   no

(NOTE: a conviction will not necessarily disqualify an applicant for employment.
Each instance will be considered in relation to the position for which you are applying.)

If yes, state the nature of the crime(s), when and where convicted and disposition of the case(s).
(Convictions for marijuana-related offenses that are more than two years old need not be listed.

Do you have any other experience, training, qualifications or skills which you feel make you especially suited for this position?
If so, please explain.

Are you licensed or certified for the job you are applying for?    yes   no

Name of license Issuing state  

License/certification number

Have you obtained any special skills or abilities as the result of service in the military? yes   no
If so, describe:

List below all present and past employment starting with your most recent employer (last 10 years is sufficient).
Account for all periods of unemployment. You must complete this section even if attaching a resume.

References
List below three persons not related to you who have knowledge of your work performance within the last three years.

Please read carefully, check 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 I am employed, regardless of the time elapsed before discovery.

I hereby authorize the company to thoroughly investigate my references, work record, education and any other matters related to my suitability for employment and further authorize the references I have listed to disclose to the company 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 company, 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 related to such investigation or disclosure.

I understand and agree that employment is "At-will", meaning employment may be terminated by either myself or the company at any time with or without cause and with or without notice. I also understand and agree that the company 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 president, no manager, supervisor or other representative of the company has authority to make any agreement, express or implied, for employment for any specified period of time, or to make any agreement for employment other than "At-will". The company 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 president of the company, indicating that it is intended as a modification of employee's "At-will" status.

Date        Signature of Applicant

PLEASE TAKE NOTICE THAT THE TACHI PALACE HOTEL & CASINO CONDUCTS PRE-EMPLOYMENT TESTING OF APPLICANTS. As a condition of employment, all "successful" applicants for jobs at THE TACHI PALACE HOTEL & CASINO will be required to take and pass a urine test for drugs and alcohol before they will be permitted to report to work. "Successful" applicants who fail to pass the drug and alcohol screen, will not be employed by THE TACHI PALACE HOTEL & CASINO.

THE TACHI PALACE HOTEL & CASINO, agaming operation, cannot provide its employees a Smoke-Free Environment.

Date        Signature of Applicant

A standard aee of $250.00 will be required of all successful applicants for a background investigation. The fee can be a payroll deduction of at least $25.00 per pay check or you can pay the fee up front.

Date        Signature of Applicant

Please type name in place of your signature. If an interview is given you will be asked to sign and
Initial this application before the interview is given.

THIS APPLICATION FOR EMPLOYMENT IS VALID FOR ONLY 30 DAYS. TO REMAIN AN ACTIVE APPLICANT, A NEW APPLICATION MUST BE FILLED OUT AND SUBMITTED TO THE COMPANY ONCE EVERY 30 DAYS.