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Deli Cashier Clinton

3 months ago

Clinton, United States Lucky Star Casino Full time

(Required) Yes No If yes, list year and location 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 Description of Military Duties Typing, Computer or Office Skills Describe any specialized Training, Apprentice Skills, or Extra-Curricular Activities. 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.

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 tribes 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).