Status Full-timePart-time
Shift DaysNightsGraveyardAny
Available to Start:
*First Name
*Last Name
Email
*Current address/PO Box Number
*City
*State---AKALAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
*Zip Code
*Home Phone
Other Phone
Do you have a valid driver's license? YesNo
Driver License #
Driver License Expiration Date
Have you ever been issued a gaming license? YesNo
If yes, by whom?
Are you 21 years or older? YesNo
Have you ever been employed with Acoma Business Enterprises? YesNo
Are you a registered Acoma Tribal Member? YesNo
If yes, what is your CIB#?
List any other names used during your employment history or schooling
Do you have any relatives employed with Acoma Business Enterprises? YesNo
If yes, please list their name, relationship and department
Have you ever been convicted of a felony? YesNo
Have you been convicted of a misdemeanor in the last 10 years? YesNo
If you answered yes to either of the last two questions, please list those convictions
High Scool Diploma? YesNo
High School Attended
GED? YesNo
College Undergraduate? YesNo
College Graduate? YesNo
College Attended
College Degree in:
Current/Last Employer
Current/Last Employer Position Title
Current/Last Employer Salary
Current/Last Employer Phone
Current/Last Employer Address
Employed from:
Employed until:
Current/Last Employer Supervisor
Reason for leaving?
Previous Employer
Previous Employer Position Title
Previous Employer Salary
Previous Employer Phone
Previous Employer Address
Previous Employer Supervisor
*List any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying: i.e. computer, software, customer service, casino experience, CPR, first aid, EMT, etc.
List three professional references. Please refrain from using immediate family members.
Name
Address
Phone
Occupation
I understand and agree that:
I certify that I have read, fully understand, and declare under penalty of perjury that the foregoing is true and correct.
Signature
Date
