General Information
Position(s) applied for:
Referral Source: Advertisement
  Employee
  Relative
  Government Employment Agency
  Walk-in
  Private Employment Agency
  Other
Name Source (if applicable):
Last Name
First Name
Middle Initial
Other Names Worked Under
Address 1
Address 2
City
State
ZIP
Telephone # (with area code)
Cell # (with area code)
Email
If necessary, best time to call you at home is AM   PM
May we contact you at work? Yes  No
If yes, work number (with area code)
Best time to call is AM   PM
Have you ever been employed here before? Yes  No
If yes, give dates From to
The Diamond Jo Casino takes every precaution to avoid conflict of interest in its employment practices, including favoritism in hiring and employment of relatives who may be in a supervisory/subordinate relationship.
Do you have any relatives employed here? Yes  No
If yes, please specify
Type of employment desired Full-time
  Part-time
  Seasonal
  Flex
Date available for work
Desired salary range $ to $
Have you ever been charged, convicted, or pled guilty or no contest to any criminal offense-felony or misdemeanor? Yes  No
If yes, please provide date and details
Employment History
Employer
Address
Telephone #
Dates employed From To
Starting job title
Final job title
Summarize the type of work performed and job responsibilities
Immediate Supervisor and title
Hourly rates/Salary Start $  Final $
Reason for leaving
If presently employed, may we contact your references? Yes No Later
 
Employer
Address
Telephone #
Dates employed From To
Starting job title
Final job title
Summarize the type of work performed and job responsibilities
Immediate Supervisor and title
Hourly rates/Salary Start $  Final $
Reason for leaving
If presently employed, may we contact your references? Yes No Later
 
Employer
Address
Telephone #
Dates employed From To
Starting job title
Final job title
Summarize the type of work performed and job responsibilities
Immediate Supervisor and title
Hourly rates/Salary Start $  Final $
Reason for leaving
If presently employed, may we contact your references? Yes No Later
 
Employer
Address
Telephone #
Dates employed From To
Starting job title
Final job title
Summarize the type of work performed and job responsibilities
Immediate Supervisor and title
Hourly rates/Salary Start $  Final $
Reason for leaving
If presently employed, may we contact your references? Yes No Later
Comments including explanation of any gaps in employment
Summarize any special training, skills, licenses and/or certificates, special accomplishments, publications, and awards etc. related to the position for which you are applying.
Education
High School Years completed Graduate? GED
Yes No
Yes No
College
(or other further education) 		Years completed Degree/Diploma GPA/Rank Major Minor

APPLICANT STATEMENT

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete, and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract or employment for any specified period or definite duration. I understand that no supervisor or representative or the employer is authorized to make any assurances to the contrary and that no implied oral or written agreement contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SUBMIT THIS FORM UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.