Date available to start
Type of employment desired:
Full TimePart Time
Position applied for
Do you know anyone currently or previously employed by Park Place?
If yes, what is your relationship to them?
Have you plead "guilty", "no contest" or been convicted of a crime?
If yes, give dates and details
Do you have a valid drivers license?
Drivers License #
High School Attended
High School Graduate
If you did not graduate, do you have GED
Degree/Area of Study
Summarize your special skills or qualifications:
Date of employment:
Reason for leaving
Signature of Applicant