GENERAL APPLICANT INFORMATION (Page 1 of 4)

First Name

*

Last Name

*

Middle Initial

*

SSN

*

Address

*

Address 2

*

City

*

State

*

Zip

*

Phone

Alternate Phone

E-mail

*

List all positions for which you would like to be considered:

Position 1

*

Position 2

*

Position 3

*

Are you a U.S. citizen?

Yes No

If no, are you authorized to work in the U.S. and can you, if offered employment, submit verification of your legal right to work in the U.S.?

Yes No

If you are seeking a casino position, are you 18 years of age or older?

Yes No

Have you ever been convicted of a crime other than a traffic violation?

Yes No

If so, explain.

Have you ever served in the military?

Yes No

Military Branch

Type of Discharge

Have you previously worked for Mount Airy Casino Resort?

Yes No

List relatives and cohabitants employed by Mount Airy and their relationship.

Have you ever had a gaming or non-gaming license revoked or been refused such?

Yes No

What date are you available to begin work?

What is your source of referral for this position?

Self/Walk-in Mount Airy Casino Resort Employee Mount Airy Casino Resort Website Friend or Relative Local Career Center Newspaper Other Internet Site Other, specify

Specify