First Name

Middle Name

Last Name

Address

City

State

Zip Code

Phone

Department Applying for Casino Hotel Restaurant Catering

Position Applying For

Status Applying for Full Time Part Time Temporary

If temporary, please indicate dates available

From

Are you available to work (check all that apply)? Weekday Day Weekday Swing Weekday Grave Weekend Day Weekend Swing Weekend Grave

First available work date

Do you have a current South Dakota Gaming License?* Yes No

What Kind? Key License Support License

To conform with State and Federal laws related to Gaming and Alcohol, are you over the age of 21? Yes No

Have you filed an application here before? Yes No

Date applied

Have you previously been employed by the Lodge at Deadwood? Yes No

Dates worked

If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No

Are you presently on a layoff and subject to recall? Yes No

Does your Visa or Immigration status prevent you from lawfully becoming employed in this country? Yes No

Have you been convicted of a crime in the last 7 years? Yes No

Please Explain

Employment Experience

Please list your last three jobs, starting with your present or most recent job. Include start/end dates, military service assignments and volunteer employment. Exclude organization names which indicate race, color, religion, sex or national origin.

Position Title

Company Name

Company Phone

Company Address

Start Date

End Date

Describe the work you did

Supervisor

Reason for leaving

Position Title

Company Name

Company Phone

Company Address

Start Date

End Date

Describe the work you did

Supervisor

Reason for leaving

Position Title

Company Name

Company Phone

Company Address

Start Date

End Date

Describe the work you did

Supervisor

Reason for leaving

Special Skills and Qualifications

Summarize any special skills and qualifications from employment or other experiences.

Upload Resume

Applicant's Statement

I certify that all information I have provided is true, complete, and correct. If any information provided is falsified, my application will be eliminated from consideration or grounds for dismissal. This application does not constitute an agreement or contract for employment for any specified period. I authorize investigation of all information herein and release the company from all liability that may result.

I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.

Digital Signature

Date

Application

Application for Employment

Employment Experience

Applicant's Statement