First Name   M.I.   Last Name

Street

City   State   Zip Code

Email   Phone   Alt. Phone

Desired Position 1   Desired Position 2

Position Status  Full Time   Part Time   On Call

Desired Shift  Day   Swing   Grave   Any

Date available to work (MM/DD/YYYY)   Expected Salary/Wage   Per Hour Year

Referred by

If you are under 21 years of age, list age:

If you have ever worked under another name, please indicate the name(s)

After an offer of employment, can you submit verification of your legal right to work in the U.S. ?   Yes   No

Can you perform the essential functions of the position(s) for which you have applied?  (Job descriptions available upon request.)   Yes   No

Have you ever been convicted of a felony?   Yes   No

If yes, what kind, where, and when?  (A conviction will not necessarily disqualify an applicant.)

Will you undergo a pre-employment drug screen?   Yes   No

Have you been or are you an employee of Peppermill or any of its affiliated companies (Western Village, Wendover or Peppermill Reno)?  Yes No

If so, when and where?  

Do you have relatives employed at the Peppermill or any of its companies?   Yes   No

If yes, provide name(s), department(s), and location(s):  

EMERGENCY CONTACT INFORMATION  

EDUCATION AND TRAINING

High School Name   City/State Major/Degree Graduate Yes  No

Community College  City/State Major/Degree Graduate Yes  No

Trade School           City/State Major/Degree Graduate Yes  No

College/University    City/State Major/Degree Graduate Yes  No

Training Program     City/State Major/Degree Graduate Yes  No

Special Skills, training, experience, or qualifications related to the position you are applying for:

Languages that you speak, read, or write:

EMPLOYMENT HISTORY

Employer  Job Title  Address

From Mo/Yr   To Mo/Yr   Supervisor   Reason for Leaving

Employer  Job Title  Address

From Mo/Yr   To Mo/Yr   Supervisor   Reason for Leaving

Employer  Job Title  Address

From Mo/Yr   To Mo/Yr   Supervisor   Reason for Leaving

Employer  Job Title  Address

From Mo/Yr   To Mo/Yr   Supervisor   Reason for Leaving

PLEASE READ CAREFULLY BEFORE SUBMITTING THIS APPLICATION

Peppermill Casinos, Inc. is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, age, handicap, or veteran status.  

I understand that (1) the use of the form does not indicate there are any positions open and does not in any way obligate Peppermill Casinos, Inc.  (2)  It is the employer’s policy to employ, retain, promote, terminate, and otherwise treat any and all employees and job applicants on the basis of merit, qualifications and competence.

I hereby certify that the information contained in the application form is true and correct to the best of my knowledge and agree to have any of the statements checked by Peppermill unless I have indicated to the contrary.  I authorize the references listed above to provide Peppermill any and all information concerning my previous employment and any pertinent information that they may have.  Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to Peppermill as well as from the use of disclosure of such information by Peppermill or any of its agents, employees, or representatives.  I understand that any misrepresentation, falsification, or material omission of information on this application may result in failure to receive an offer or, if I am hired, in my dismissal from employment.

In consideration of my employment, I agree to conform to the rules and standards of the company and agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the company.   I understand that no employee or representative of the company other than the President of the company has any authority to enter into any agreement contrary to the foregoing.  Further, the President of the company may not alter the at-will nature of the employment  relationship unless he does so specifically and in writing.  I also understand that all offers of employment are conditioned on the provision of satisfactory proof of any applicant’s identity and legal authority to work in the U.S.

                                                                                         Revised June 27, 2008

By submitting this application I certify that I have read and understand the above statement.