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License/Certification $/ $  ::0   ::1   ::2  '::3 'Apprenticeship dd    '((  ' 'dd ' 'dd ' 'dd '(dd    (#XX #ٻ XXL#XX ٻ%# dYYYY)!dxdx(.3$ !USUS.,  ݀Level 1Level 2Level 3Level 4Level 5)!dxdx( $ Figure  1  8`b&Draw Object =8C HKKKKTABLE A_cb&OLE 2.0 Box <=8C HKKKK TABLE BԑTABLE C9Hairline!dxdxqqqq)!dxdx  d2222)!dxdxuuuu)!dxdx dwwww)!dxdx dyyyy)!dxdx&0 d d{{{{)!dxdx&P d d}}}})!dxdx&p d Pd)!dxdx&p Pd d)!dxdx3+0 d d d3+0 d d dTABLE D(.3$ !USUS.,  >Thick Double Pd Pd_{  <<= 8C_ZE<<CLevel 1Level 2Level 3Level 4Level 5($$   1  !USUS.,  _,,  XXONEIDATRIBEOFINDIANSOFWISCONSIN#XX#LJXX@&&R&#XXJL#  RQXXHUMANRESOURCESDEPARTMENT#XXQRP# SXX@&&R&#XX S# u XXP.O.BOX365,ONEIDA,WI54155#XX#   EMAILADDRESS:HRDDEPT@ONEIDANATION.ORG  APPLICATIONFOREMPLOYMENT  Ih  (PLEASEPRINTCLEARLY)  uHowdidyouhearaboutthisposition?0 < oNewspaperAd0D<&<&qInternet0D&D&0L&&qOther򀀀 , L&L&      4    < qFriend/Family0 D qJobService0LD&D&oPostedinoffice  L&L&   Answerallquestionscompletely.Incompleteapplicationsmayberejected.   **Anyapplicationreceivedaftertheclosingdatewillnotbeconsidered**   Aseparateapplicationisrequiredforeachpositionapplyingfor.    ٻ XX5p 533PositionApplyingFor:򀀀0  Job#:򀀀&& 3Name򀀀  3      ٻLast0 4 0 4&4&0 & &0< & &First0<&<&0&&0D&&0D&D&Middle#ٻ  #0&&  ٻ0L&&0L&L&Maiden#ٻ   #&& 3Address:򀀀  3    ٻNumber0 4 Street0 4&4&0< & &0<&<&City0D&&0D&D&State0L&&ZipCode0!L&L&County!&!& #ٻ  ' #TelephoneNumber:(򀀀)򀀀󀀀MessageNumber:(򀀀)򀀀 t TribalAffiliation:򀀀󀀀EnrollmentNumber:򀀀 4 @VuAAAA!a@  {WG73h L'"% `@XE,V% ?%,F%{ Vu 8LSummarizespecialskills:򀀀 ,-+ 򀀀 󀀀 Z-y,  ________________________________________________________________________________________ LL .- 0  0&&04&&0 4&4&0 & &0< & &0<&<&0&&0D&&0D&D&  ^ \ ٻ L    ! // &&      4    <      D      L    ! Revised12/22/2004#ٻ  \^#  0/! _,LO\AreyouaVeteranoftheU.S.MilitaryService?0  Yes/Noa&& (IfyouarerequestingVeteransPreferencepleaseprovideacopyofyourDischargepapers󀄀DD214).  T$       EMPLOYMENTHISTORY : (Providethefollowinginformationstartingwithyourpresentposition)   * Yddd Xdd Xdd X,&,&,/ dd ,Qdd +   From:(mo/day/yr)To:(mo/day/yr) Gf    G f  EmployerName: Gf  Telephone:()  G f  Title:    Address:    Supervisor: o  Title:  o Summarizejobduties/responsibilities:  o  HourlyWage:  "  $" $ReasonforLeaving:     (   (*#Y$dd/ dd / Qdd Q Y,&,&,/ dd ,Qdd +   From:(mo/day/yr)To:(mo/day/yr)  +J EmployerName: +J Telephone:()  +J Title:   Address:    Supervisor: Sr! Title:  Sr# Summarizejobduties/responsibilities:  Sr$ HourlyWage:  %  $& $ReasonforLeaving: { '   {! ( ({ )   (*%Y&dd/ dd / Qdd Q#Y$,&,&,/ dd ,Qdd +  #"*#" From:(mo/day/yr)To:(mo/day/yr)  $.#+ EmployerName: $.#, Telephone:()  &.%. Title:  '&/ Address:  '&0 Supervisor: 7)V(1 Title:  7+V*3 Summarizejobduties/responsibilities:  7)V(4 HourlyWage:  ,+5  $,+6 $ReasonforLeaving: _.~-7   _/~.8 (_.~-9   (^ \ ٻ     4    <      D 0  0&&0L&&0L&L&0!&&Revised12/22/2004 180:!&!& O\ w,   #ٻ  \^ϳ#  SHEMPLOYMENTHISTORY: 󀀀(continued) w **Y+dd/ dd / Qdd Q%Y&,&,&,/ dd ,Qdd +  {{ From:(mo/day/yr)To:(mo/day/yr)  h EmployerName: h Telephone:()  h Title:  s Address:  s Supervisor:  Title:     Summarizejobduties/responsibilities:    HourlyWage:   $   $ $  $ReasonforLeaving: /    /  (/    (*,Y-dd/ dd / Qdd Q*Y+,&,&,/ dd ,Qdd +  __ From:(mo/day/yr)To:(mo/day/yr)  L EmployerName: L Telephone:()  L Title:  W Address:  W Supervisor: t Title:  t Summarizejobduties/responsibilities:  t HourlyWage:    $ $ReasonforLeaving:     (    (*.Y/dd/ dd / Qdd Q,Y-,&,&,/ dd ,Qdd +  C!C From:(mo/day/yr)To:(mo/day/yr)  0" EmployerName: 0# Telephone:()   0% Title:  ;" & Address:  ;" ' Supervisor: #X"( Title:  %X$* Summarizejobduties/responsibilities:  #X"+ HourlyWage:  c'%,  $c'%- $ReasonforLeaving: ('.   )(/ (('0   (JAdditionalinformation,includingaresume,maybeattachedtothisapplication. '+)0 Arethereanyemployersdonotwantustocontact?Ifyes,pleaseexplain: ,0+2 򀀀 '.,4 򀀀 /0.6  ^ \ ٻ      4    <      D      L    ! Revised12/22/2004 #ٻ  \^y*# '1/8  1:09 SH S,w S   XX ٻPleasereadandinitialeachofthefollowingstatements.Ifyouhaveanyquestionsregardinganyofthesestatements, , discusswithaHumanResourcesrepresentativepriortoinitialingandsigning.Yourinitialsandsignatureverifythat  youhaveread,understand,andagreetothesestatements.    Initial:  Ӏ0  TheOneidaTribeofIndiansofWisconsinwillnotberesponsibleforthecompletenessofthis>&&     application.Itistheapplicantsresponsibilitytofillouttheapplicationformcompletely. * Initial: `  Ӏ0  Myemploymenthistory(ifany)withtheOneidaTribeofIndiansofWisconsinmaybeutilizedand/or    reviewedindeterminingmyeligibilityfortheposition. && Initial:   򀀀0  Iherebycertifythatallstatementsmadeon,orinconnectionwithmyapplicationaretrue,completeand   correcttothebestofmyknowledge.Ialsounderstandthatemploymentandeducationverificationwill  r  beconducted. Iunderstandthatifanyfalseinformation,omissions,ormisrepresentationsare ^  discovered,myapplicationmayberejectedand,ifemployed,myemploymentmaybeterminated zN atanytime. f:&&  Initial: > 򀀀0  Allinformationderivedpursuanttotheemployeebackgroundinvestigationwillbeconfidentialbythe * OneidaTribe.ThisapplicationbecomesthepropertyoftheOneidaTribeofIndiansofWisconsin.&& Initial: xL Ӏ0  Iherebyauthorizeallpersonsandentitiestowhomthisreleaseispresentedhavinginformationrelating  toorconcerningme,tofurnishanyandallsuchinformationtoanyagentoftheOneidaHuman  Resourcesand/orOneidaGamingCommissionforpurposesofemploymentwiththeOneidaTribeof  IndiansofWisconsin.r&&   0  Anyreproductionofthisrelease,whetherphotocopy,fax,orotherprocess,shallbeconsideredasvalid  astheoriginal.Employersareherebyreleasedfromanyandallliabilitywhichmayresultfrom   furnishingsuchinformation.  <      D   !&& Signature:򀀀0  Date:򀀀#ٻ XX+#Ԁ^ \ ٻ#&&     #ٻ  \^C8# ٻ  GAMINGOPERATIONSAPPLICANTSONLY  % (INCLUDINGSURVEILLANCE,MISGAMING,INTERNALSECURITY)  ! & #ٻ ѿ8#8   NM(03QP ٻPX\XPMysignaturebelowindicatesmyagreementwiththefollowingstatements: $"( 0  IfemployedbytheOneidaTribeofIndiansofWisconsin,IagreetosubmittothejurisdictionoftheTribe,and~%R$*&&   allboards,agenciesandtribunalsoftheTribe. j&>%+   0  IagreetoabidebyallapplicableTribalandfederallaws,regulationsandpoliciesduringmyemploymentwith'&-&&   theOneidaTribeofIndiansofWisconsin. ('.   IhavereadandunderstandthenoticesandNIGCrequirementsrelatedto: *(0 #XXXPX\>:#PX\XXX      (1)0 4 #XXXPX\=#PX\XXXThePrivacyActof1974,+)14&4&       (2)0 4 #XXXPX\!>#PX\XXXFalseStatements,+*24&4&     (3)0 4 #XXXPX\>#PX\XXXCreditReporting,and,+34&4&     (4)0 4 OneidaPrivacyPolicy.-,44&4&   <( 4 <DLX<  YoumayasktheHRReceptionistforacopyofthePrivacyActof1974andOneidaPrivacyPolicy. ,/.6   #XXXPX\f?#Signature:򀀀0  Date:򀀀#ٻ XX]:#Ԁ^ \ ٻ @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  @l&  1/8 ЀRevised12/22/2004#ٻ  \^B# 209&& ,*Y'dd/ dd / Qdd Q.Y/,&,&,%dd +   Haveyoueverusedorareyouotherwiseknownbyanothername?Ifso,pleaselistallsuchnames Ed (includingnicknameandmaidenname): Ed Ѐ1.򀀀0 P 3.򀀀PH&PH& Ѐ2.򀀀0 P 4.򀀀EdPH&PH& DPreviousAddress(es)forthelastten(10)years:  Ѐ1.򀀀0 P 4.򀀀Ed PH&PH& Ѐ2.򀀀0 P 5.򀀀  PH&PH& Ѐ3.򀀀0 P 6.򀀀E d PH&PH& F  Haveyoueverreceivedapardonforacriminaloffense?Yes/No   ЀIfyes,listwhen,where,andifitwastribal,stateorfederal. Ed    򀀀     Ed J    I   (Useaseparatesheetforcontinuation)   NM  *l;Y<dd%dd %Y',&,&l,%dd +    XX ٻ(Pleaseprintlegibly)#ٻ XXrN#  Wv SocialSecurityNumber:򀀀DateofBirth:򀀀 Cb DriversLicense#/ID:򀀀State:򀀀󀀀CDLLicense:oYesoNo Cb Gender:oMale/oFemalePrintName:򀀀 Cb!  Cb" @* 5zs5 0 ٻ  0 @ @, ***ForHRD/Background/OGCToComplete***#ٻ 0jQ# 0@&& # QQHRRep:򀀀0  0&&Position:򀀀! %&& SendDriverAbstract:oYes/oNo  0  oGaming0&&Code:򁀀"!&&& XX ٻ     4    <      D   #ٻ XX T#DateSent:򀀀XX ٻ ##' Ӏo#ٻ XXU#ԀApplicantmeetsthebonding/backgroundcriteriaforthepositionappliedforonthisapplication OR  &2%) 810qqqq!2Q@X,X,