Contact Information Page 1 of 9 Please complete our online application below. All fields with an asterisk(*) are required. Use the Login field to create a user name to be used to access the Self Service module to apply for position in the future or to update your information. Login* First Name* Middle Name* Last Name* Previous Name Nickname Home Street 1* Home Street 2 Home City* Home State/Province* Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oren Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Home Zip/Postal Code* Country* Canada Mexico United Kingdom USA Home Phone* Work Phone Work Extension Fax Cell Phone Primary Phone Home Work Cell Email How did you learn about this opening?** Billboard Career Builder CPN Employment and Training Current Employee Referral Customer Referral Employee Referral Employee Referral External Flyer/Handout Internal Applicant Job Fair Mass Mailout Monster.com Newspaper Radio Advertisement TRAO TV Ad University Job Posting Workforce Oklahoma If referred by a current employee, what is his/her name? Have you had any previous training that will enable you to perform the job functions?* No Yes If Yes, what training or experience do you have in this field? Full-Time or Part-time?* Full-Time Part-Time What hours can you work?* 11:00 PM to 7:00 AM 12:00 AM to 12:00 PM 12:00 PM to 12:00 AM 3:00 PM to 12:00PM 8:00 AM to 5:00 PM Open What days can you work?* Monday Through Friday Open Thursday Through Sunday If required, would you work a schedule other than Monday through Friday?* No Yes If required, would you work overtime?* No Yes If required, would you work a rotational work schedule?* No Yes If required, would you work shift work?* No Yes Are you able to perform the essential functions of the position(s) you are applying for with or without reasonable accommodations?* No Yes If reasonable accommodations are required, what would those be? Have you ever been convicted of a felony?* No Yes If Yes, please give specific dates, charges and court of record information? Have you ever been bonded?* No Yes If YES, with what Employer? Are you currently going to school?* No Yes If yes, what is current class schedule? Do you have any relatives employed by or associated in a business relationship with Citizen Potawatomi Nation and/or FireLake Enterprises?* No Yes If yes, please list their names and relationship to you: Are you an enrolled member of Native American Tribe?* No Yes-CPN Tribal Member Yes-Other Tribal Member Have you ever been employed by Citizen Potawatomi Nation/FireLake Enterprises?* No Yes If Yes, what were your dates of employment? Have you ever been issued or applied for a gaming license?* No Yes If previously licensed, when and through which regulatory agency?