COLVILLE TRIBAL GAMING COMMISSION (2024)

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COLVILLE TRIBAL GAMING COMMISSION

729 JACKSON STREET

P.O. BOX 1647

OMAK, WASHINGTON 98841

(509) 422-7715 / (509) 422-7719 FAX

Colville Gaming License Application

CTGC Resolution 2005-010

Revised: Resolution 2011-020

Revised: Resolution 2013-033

Revised TGC 2014-161

Revised: TGC 2016-195

Revised: Resolution 2017-018

Revised: TGC 2018-152

Revised: Resolution 2021-005

Revised: TGC 2024-153, 6-18-2024

March 26, 2021

Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

OVERVIEW OF COLVILLE TRIBAL GAMING:

1. Pursuant to sovereign powers that predate the United States, the Confederated Tribes of

the Colville Reservation (Tribes) have governmental authority over all gaming operations

within their jurisdiction.

2. Currently, there are three Colville casinos (12 Tribes Resort, Coulee Dam, and Mill Bay),

operated by the Colville Gaming LLC, a wholly owned tribal corporation.

3. Pursuant to Colville law, responsibility for enforcing Colville tribal gaming law and

regulations, as well as applicable federal and state laws and regulations, has been

delegated to the Colville Tribal Gaming Commission. See Colville Tribal Code Section

6-5 (Gaming).

4. In accordance with Colville law, all tribal gaming licenses are issued by the Colville

Tribal Gaming Commission.

5. The Indian Gaming Regulatory Act of 1988 (IGRA), 25 U.S.C. 2701 et seq., is a federal

law that applies to Class II and Class III Indian gaming. IGRA includes the following

requirements for Colville tribal gaming operations:

a. All Colville Gaming LLC gaming employees are required to obtain a tribal

gaming license as a condition of employment.

b. An extensive background investigation is required for each tribal gaming license.

c. An Indian Tribe may not issue a license to any person who poses a threat to the

public interest or the effective regulation of tribal gaming.

d. A detailed report on each employee’s eligibility and qualifications for a gaming

license must be submitted to the National Indian Gaming Commission.

e. Indian Tribes are required to enter into a Tribal-State Compact on Class III

gaming.

6. The Tribes have entered into a Tribal-State Compact with the State of Washington which

includes a review of Class III Colville tribal gaming licenses by the Washington State

Gambling Commission.

7. The Tribes have entered into a Memorandum of Understanding (MOU) regarding the

dissemination of criminal history record information (CHRI) from the Federal Bureau of

Investigation (FBI) by the National Indian Gaming Commission which includes prior to

taking applicant’s fingerprints, the Tribe agrees to adhere to those standards outlined in

this MOU.

Revised: TGC 2024-153, 6-18-2024

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INSTRUCTIONS FOR THE GAMING LICENSE

APPLICATION PROCESS

Review the Colville Individual Licensing Regulations (Regulations) and

make sure that you meet the qualifications for a gaming license.

Licensing requirements are strictly enforced by the Colville Tribal

Gaming Commission.

Make sure you have completely and accurately filled out the application.

a. Colville Gaming LLC employees: your completed application is

forwarded to the Colville Tribal Gaming Commission Licensing Analyst

by the casino’s Human Resources Analyst, who is processing your

application for employment.

b. Colville Tribal Gaming Commission employees: your completed

application is submitted directly to the Colville Tribal Gaming

Commission Licensing Analyst.

Initial processing of gaming license applications takes place prior to

Casino’s orientation which is usually on Wednesdays of each week.

It may take up to 10 regular business days to complete a preliminary

determination of your eligibility for a temporary gaming permit.

(See Section 2.050 of the Regulations for a description of the backgrounds investigation process.)

Bring with you the following required items:

a. Driver’s license or state-issued identification (must be unexpired).

b. Social Security card.

c. Tribal identification, if applicable.

d. Alien or naturalization registration card, if applicable (must be

unexpired).

If you have recently been married, divorced, or changed your name and

your identification documents have not been updated, bring your

marriage certificate, divorce, or other court decree which shows a change

of marital status and/or name.

If you have any documents which may affect your eligibility for a

gaming license, including court orders, bring them with you.

Revised: TGC 2024-153, 6-18-2024

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NOTE: AN INCOMPLETE APPLICATION WILL NOT BE PROCESSED AND MAY RESULT IN THE AUTOMATIC DENIAL OF A

GAMING LICENSE

. (See Section 2.060 of the Commission’s “Individual Licensing Regulations”)

Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

APPLICATION FOR COLVILLE GAMING LICENSE

Please Read In Compliance with the Federal Privacy Act of 1974, the

following information is provided:

Solicitation of the information on this form is authorized by 25 U.S.C. §§ 2701, et seq. The

purpose of the requested information is to determine the eligibility of individuals to be granted a

gaming license. The information will be used by the Tribal Gaming regulatory authorities and

the National Indian Gaming Commission (NIGC) members and staff who have need for the

information in the performance of their official duties. The information may be disclosed by the

Tribes or the NIGC to appropriate Federal, Tribal, State, local or foreign law enforcement and

regulatory agencies when relevant to civil, criminal or regulatory investigations or prosecutions

or when pursuant to a requirement by a Tribes or the NIGC in connection with the issuance,

denial, or revocation of a gaming license, or investigations of activities while associated with a

Tribes or Gaming Operation. Failure to consent to the disclosures indicated in this notice will

result in a Tribes being unable to license you as a tribal gaming employee, including primary

management official or key employee positions.

The disclosure of your Social Security Number (SSN) is voluntary. However, failure to supply a

SSN may result in errors in processing your application.

A false statement on any part of your license application may be grounds for denying a license or

the suspension or revocation of a license. Also, you may be punished by fine or imprisonment

(U.S. Code, title 18, section 1001).

Revised: TGC 2024-153, 6-18-2024

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Please Read In Compliance with the NONCRIMINAL JUSTICE APPLICANT’S

PRIVACY ACT, the following information is provided: As an applicant who is the subject of a

national fingerprint-based criminal history record check for a noncriminal justice purpose (such as an application for

employment or license, an immigration or naturalization matter, security clearance, or adoption), you have certain

rights which are discussed below. All notices must be provided to you in writing (written notification includes

electronic notification, but excludes oral notification). These obligations are pursuant to the Privacy Act of 1972,

Title 5, United States Cod (U.S.C.) Section 552a, and Title 28 Code of Federal Regulations (CFR), 50.12, among

other authorities.

* You must be provided an adequate written FBI Privacy Act Statement (dated 2013 or later) when you submit your

fingerprints and associated personal information. This Privacy Act Statement must explain the authority for

collecting your fingerprints and associated information and whether your fingerprints and associated information

will be searched, shared, or retained. https://www.fbi.gov/services/cjis/compact-council/privacy-act-statement

* You must be advised in writing of the procedures for obtaining a change, correction, or update of your FBII

criminal history record as set forth at Title 28 CFR 16.34.

* You must be provided the opportunity to complete or challenge the accuracy of the information in your FBI

criminal history record (if you have such a record).

* If you have a criminal history record, you should be afforded a reasonable amount of time to correct or complete

the record (or decline to do so) before the officials deny you the employment, license, or other benefit based on

information in the criminal history record.

* You have the right to expect that officials receiving the results of the criminal history record check will use it only

for authorized purposes and will not retain or disseminate it in violation of the federal statute, regulation or

execution order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact

Council. See 5 U.S.C. 552a(b); 28 U.S.C. 534(b); 34 U.S.C, § 40316 (formerly cited as 42 U.S.C. 14616), Article

IV(c); 28 CFR 20.21(c), 20.33(d) and 906.2(d).

* Agency policy does not permit us to provide you a copy of the record, however, you may obtain a copy of the

record by submitting fingerprints and a fee to the FBI. Information regarding this process may be obtained at

http://www.fbi.gov/about-us/cjis/backgrounds-checks

* If you decide to challenge the accuracy or completeness of your FBI criminal history record, you should send your

challenge to the agency that contributed the questioned information to the FBI. Alternatively, you may send your

challenge directly to the FBI by submitting a request via http://www.edo.cjis.gov. The FBI will then forward your

challenge to the agency that contributed the questioned information and request the agency to verify or correct the

challenged entry. Upon receipt of an official communication from that agency, the FBI will make any necessary

changes/corrections to your record in accordance with the information supplied by that agency. (See 28 CFR 16.30

through 16.34.)

Revised: TGC 2024-153, 6-18-2024

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Section One

A. Full Legal Name:

Last:

Other names used:

First:

Middle:

List all names used including aliases, maiden name, married names, nick names (written or oral)

B. Tribal Affiliation:__________________________ Enrollment # ___________

C. Height:

Weight:

Eye Color:

Hair Color:

Gender: Male

Female

All languages (spoken or written):

Birthmarks, Scars, Tattoos, or distinguishing marks:

D. Date of Birth:

Place of Birth:

City

Age:

SSN:

County

State

E. Are you a citizen of the United States?

Yes

Country

F. If Alien, Registration Number:

G. If Naturalized, Naturalization Number:

Date:

Place:

Month/day/year

Employment position(s) for which you are applying:

Date of your application:

Month/day/year

Marital Information: Single:

Married:

Divorced:

Widowed:

Engaged:

Spouse’s Full Name (family/maiden name):

Phone:

Residence Address:

Separated:

Section Two

A. Current Home Address

Physical Address

Mailing Address

Street Address

City

State

Zip Code

(If different than physical address)

Telephone Numbers:

Home :(

)

Work, Cell, or Message: (

)

If you rent or lease your residence, provide the name and address of the person

responsible for collecting the rent/lease payments:

Name

Revised: TGC 2024-153, 6-18-2024

Complete Address

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Telephone Number(s)

B. Previous home addresses during the past ten years

(If you need additional space, use a separate page.)

Physical Address:

Street Address

City

State

Zip Code

Street Address

City

State

Zip Code

Street Address

City

State

Zip Code

Street Address

City

State

Zip Code

C. Current Business Address, including the previous five years

Business Address

Street Address

City

State

Zip Code

Business Telephone Number(s): ( )

Section Three

A. Family. List three relatives with whom you have a close personal

relationship (including children). Provide a complete physical address and

include name, mailing address, city, state, zip code, and phone numbers.

Name and Relationship

Complete Current Address

Complete Phone Number

B. Personal References – Not Related. List at least three individuals who

have knowledge of you and your qualifications. Exclude relatives and

former employers. Include one personal reference who was acquainted with

you during each period of residence listed in Section Two (B). Provide

name, complete mailing address, and phone numbers for each person.

(If you need additional space, use a separate page.)

Name and Relationship

Revised: TGC 2024-153, 6-18-2024

Complete Current Address

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Complete Phone Number

C. Residents or Roommates. List all individuals with whom you have resided

during the past ten years. Provide the name, complete mailing address,

city, state, zip code, and phone numbers for each person.

(If you need additional space, use a separate page.)

Name and Relationship

Complete Current Address

Complete Phone Number

Section Four - Experience and Employment

Beginning with your most current employment, list all business and employment

positions held during the previous five years (including part-time, temporary, and

voluntary). For identification and verification, indicate the nature of the activity;

i.e., full-time, part-time, or voluntary. Provide complete addresses and phone

numbers. (Use a separate page if you need additional space).

NOTE: If you have had intermittent periods of military service or unemployment, list those

periods in sequence in the spaces provided.

Dates of Employment:

Name and Address of Employer:

Name/Title of Supervisor:

From:

__________/__________

To:

Name(s) of Co-Workers:

__________/__________

Phone Number:

Full-Time __________

Title and Duties:

Part-Time __________

Voluntary __________

Reason for Leaving:

Military

Unemployed

From:

Dates of Employment:

Name and Address of Employer:

From:

__________/__________

To:

__________/__________

Phone Number:

Full-Time __________

Title and Duties:

Part-Time __________

To:

Name/Title of Supervisor:

Name(s) of Co-Workers:

Voluntary __________

Reason for Leaving:

Military

Unemployed

Revised: TGC 2024-153, 6-18-2024

From:

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To:

Section Five - Education

A. Did you graduate from high school or complete a G.E.D. program?

Yes

B. Have you ever been enrolled in college or a specialized technical training

program?

Yes No

C. For each school or college you have attended, provide the name of the school,

address, contact person, telephone number, the date(s) of enrollment, course of

study, and whether you graduated, received a degree or certificate, are currently

taking classes, did not finish (DNF). Provide additional information, as needed.

School’s Name:

School’s Address:

School’s Phone

Number:

Attendance or

Enrollment Dates:

Graduated (degree)

Attending, DNF

Section Six - Military Experience

A. Have you ever served in the Armed Forces, National Guard, or Reserve?

If “yes” provide the following information.

Yes

Branch of Military Service / Dates of Service

Service Number:

From:

To:

Type of Discharge:

B. Are you currently participating in any Military Reserve or National Guard

program?

Yes No

Revised: TGC 2024-153, 6-18-2024

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Section Seven - Charges, Arrests, and Convictions

A. For each criminal and non-criminal charge, arrest and conviction (including

juvenile cases, traffic and civil infractions) within ten years of the date of this

application, describe the charge, give the name and address of the court,

including the county where the court is located, and state whether there is an

ongoing prosecution or there was a disposition/conviction. Attach a copy of

any court orders.

(Use a separate page if you need additional space)

Date

Charge

Name, Address of the

Court

Finding, Judgment,

Disposition, Fine

B. For each felony charge, arrest and conviction, describe the charge, give the

name and address of the court, including the county where the court is located,

and state whether there is an ongoing prosecution or there was a

disposition/conviction. Attach a copy of any court orders. (Use a separate page

if you need additional space)

Date

Charge

Name, Address of the

Court

Finding, Judgment,

Disposition, Fine

C. Have you ever been charged, arrested or convicted under any other name?

If “yes,” provide the name, date, charge, name, address, and county

Yes No

of the court involved, and the findings, judgment, or disposition of the case.

D. Have you ever testified before a federal, state, tribal, or county grand jury,

board, or commission?

Yes No

If “yes,” provide contact information for the grand jury, board, or commission. Also explain

what your involvement was and for what reason.

Revised: TGC 2024-153, 6-18-2024

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E. Do you currently have any civil cases pending for or against you? Yes

F. Have you ever been placed on court probation?

Yes

NOTE: If you answered “yes” to any question in this section, provide a complete

explanation on a separate page.

Section Eight

A. Driving Record (current and previous five years)

Driver’s License Number:

Issuing State/Province/Country:

Expiration Date:

Driver’s License Number:

Issuing State/Province/Country:

Expiration Date:

Driver’s License Number:

Issuing State/Province/Country:

Expiration Date:

B. Other states, provinces or countries where you have been licensed to operate a

motor vehicle:

State/Province/Country:

Name under which license was Name under which license was Name under which license was

granted:

License Number:

C. Have you every had a driver’s license revoked?

License Number:

Yes

D. Have you ever been refused a driver’s license by any state, province or country?

Yes No

If you answered “yes” to C or D, provide a full explanation (include when, where, and why).

Revised: TGC 2024-153, 6-18-2024

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Section Nine - Financial Record

A. Have you ever filed for or declared bankruptcy?

Yes

B. Have you ever been reported to a collection agency?

Yes

C. Have you ever had “purchased goods” repossessed?

Yes

D. Have your wages ever been garnished?

Yes

E. Have you ever been delinquent on income tax or other tax payments? Yes

If “yes,” provide full details (include when, where, and why).

This includes unpaid fines, judgments, etc…

“Purchased goods” include items such as cars, furniture, appliances, electronics, etc.

If “yes,” provide full details (include what, when, where, and why).

If “yes,” provide full details (include when, where, why, and by what agency).

If “yes,” provide full details (include when, where, and why).

Revised: TGC 2024-153, 6-18-2024

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Section Ten - Gaming and Licensing

A. Describe current and any previous five years or existing business relationships with

Indian Tribes or with the gaming industry generally, including ownership interests in

those businesses.

B. Financial or any other interest in gaming activities:

Indicate whether you have a financial interest in any gaming activity, including a non-Indian

business or interest.

Have you ever invested in or loaned money to any gaming facility or activity?

Yes No

Have you ever had an option to purchase or a contract to provide services to any

gaming facility or activity?

Yes No

Do you own or have an ownership interest in any equipment being leased or

otherwise provided to any gaming facilities?

Yes No

Do you have investment or ownership interests in any business involved in any

activities listed herein?

Yes No

Have you ever worked in any capacity for a gaming operation?

Yes

C. Have you ever applied for a permit or a license related to gaming?

Yes

If you answered “yes” to any of the above questions, provide a full explanation on a separate page.

Have you ever had a permit or license related to gaming denied, revoked, or

suspended?

Yes No

If you answered “yes,” to either of the above questions, provide the following information:

Type of License:

State:

License Number:

Expiration Date:

Agency Issuing License:

Agency Address:

If this license was denied, revoked, or suspended, provide all the details, and explain why:

Revised: TGC 2024-153, 6-18-2024

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D. Have you ever held or applied for, or been denied a privileged or professional

license with any licensing or regulatory agency?

Yes No

(This includes a liquor license, realtor’s license, nursing license/certification, law license, etc.)

If “yes,” provide the following information, including the issuing agency, address, etc.

Type of License:

Issuing Agency and

Address

License Number:

Expiration Date:

(date of denial)

Important

I certify that all statements made in this application document are TRUE, COMPLETE, and

CORRECT to the best of my knowledge and belief, and are made in good faith. I am aware that

the purpose of this investigation is to determine my eligibility for a gaming license. I authorize

and grant my consent to permit any law enforcement agency and any other person, business or

agency deemed necessary, to release any information to the Tribes, National Indian Gaming

Commission and the Washington State Gambling Commission. I understand that failure to

answer any question on this application completely and truthfully may result in the denial of a

gaming license.

Full Legal Name:

(Please print)

Last Name

Date of Birth:

First Name

Social Security Number:

Signature:

Revised: TGC 2024-153, 6-18-2024

Middle Name

Date:

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Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

AUTHORIZATION TO RELEASE INFORMATION

As an applicant for a gaming license with the Colville Gaming Commission, I am required to furnish

information for use in determining my qualifications and eligibility for a Colville Gaming License. The

Colville Tribal Gaming Commission is authorized to ask for this information pursuant to authority

granted by federal and Colville tribal law. The release of the information requested is voluntary.

However, failure to complete this release may result in an incomplete application. The purpose of this

request for information, and the authorization of this release, is for the sole purpose of determining my

gaming license qualifications and eligibility.

As a license applicant, I understand that this release will remain in effect for the duration of my license

with the Colville Tribal Gaming Commission. This release will expire upon my termination of

employment with the Colville Gaming LLC or with the Colville Tribal Gaming Commission. I also

understand that periodic review of my background will continue after a Colville Tribal Gaming License is

granted, and that I am responsible for maintaining current information in my application file.

This document authorizes release of requested information, whether or not such information would

otherwise be protected from disclosure by any constitutional, statutory or common law privilege. I

authorize review and copying of all documents.

I agree to accept any risk of adverse public notice, embarrassment, criticism or financial loss that may

result from use of information that is obtained in connection with a background investigation for the

purpose of determining my qualifications and eligibility for a Colville Tribal Gaming License.

I authorize release of any information related to my activities, including schools, property interests (real

and personal), employment, criminal justice agencies, regulatory agencies, businesses, financial and

lending institutions. I acknowledge and agree that any inquiry may include information as to my

character, general reputation, personal characteristics, and mode of living.

I relinquish any right that I may otherwise have to pursue a cause of action against any person (or his or

her agent) to whom this request is presented when such cause of action arises out of response to a request

for information pursuant to the Indian Gaming Regulatory Act (25 U.S.C.2701, et seq.). I further agree to

indemnify and hold harmless any person to whom this request is lawfully presented. Such

indemnification and holding harmless includes all claims, damages, losses and expenses, including

reasonable attorney fees.

Last Name:

Date of birth:

First Name:

Social Security Number:

Applicant’s Signature:

Revised: TGC 2024-153, 6-18-2024

MI:

Date:

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Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

MEMORANDUM OF UNDERSTANDING

I, ____________________________________, understand that I am being accepted on a

preliminary basis for a Temporary Gaming Permit by the Colville Tribal Gaming Commission. I

understand that I will be asked questions pertaining to my background investigation which I must

answer truthfully and completely. If at any time throughout my background investigation it is

determined that I did not provide material information or that the information I provided was

false or misrepresented in any manner, further consideration for a Gaming License by the

Colville Tribal Gaming Commission must be reviewed by the Director of the Gaming

Commission and my application may be denied.

I understand that my Temporary Gaming Permit is conditional until my background investigation

is completed. By signing below, I am stating that the information I have provided to the Colville

Commission Licensing Investigator is complete, true and correct to the best of my knowledge. I

also understand that inquiries regarding my continued qualification and eligibility for a Gaming

License may be made as needed. I hereby authorize any such inquiries to be made, as

determined necessary by the Colville Commission Licensing Investigator, including criminal and

credit history checks.

Applicant Signature:

Date:

Licensing Analyst:

Revised: TGC 2024-153, 6-18-2024

Date:

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Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

PRIVACY ACT NOTICE

In Compliance with the Privacy Act of 1974, 5 U.S.C. 552a, as amended, applies to the

information provided in your application for a Colville Tribal Gaming License. This federal law

is also known as the Freedom of Information Act (FOIA).

The Indian Gaming Regulatory Act (IGRA), 25 U.S.C. §§ 2701, et seq., and IGRA regulations,

rules and procedures apply to tribal gaming licenses. IGRA requires that this information be

provided to the National Indian Gaming Commission, a federal agency under the Privacy Act.

The Privacy Act requires that documents submitted by tribes to federal agencies be treated the

same as any other records under FOIA. This means that these documents are public information

unless they fall under one of nine exemptions.

The purpose of the requested information is to determine the eligibility of individuals to be

granted a gaming license. The information will be used by the Colville Tribal Gaming

Commission, the National Indian Gaming Commission and staff who have a need (such as the

Washington State Gambling Commission (WSGC or State)) for the information in the

performance of their official duties. The information may be disclosed by the Tribes or NIGC to

appropriate Federal, Tribal, State, local or foreign law enforcement and regulatory agencies

when relevant to civil, criminal or regulatory investigations or prosecutions or when pursuant to

a requirement by a Tribes or the NIGC in connection with the issuance, denial, or revocation of a

gaming license, or investigations of activities while associated with a Tribes or Gaming

Operation. Failure to consent to the disclosures indicated in this notice will result in the Tribes

being unable to license you as a tribal gaming employee, including primary management official

or key employee positions.

The disclosure of your Social Security Number (SSN) is voluntary. However, failure to supply

your SSN may result in errors in processing your application.

FALSE STATEMENT NOTICE

A false statement on any part of your application may be grounds for denying a license or the

suspension or revocation of a license. Also, you may be punished by fine or imprisonment (U.S.

Code, title 18, section 1001).

Last Name:

First Name:

Middle Initial:

Date of birth: ____________________________ Social Security Number:

Applicant’s signature: ______________________________________ Date:

Revised: TGC 2024-153, 6-18-2024

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Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

APPLICANT ASSURANCES

have read and understand the below

information, which includes cited sections of the Colville Tribal Gaming Commission Individual

Licensing Regulations (“Regulations”).

I acknowledge, accept, and understand the following:

1. Consent of civil jurisdiction of the Tribes, Commission, or the Tribal Court. See

Colville Tribal Code Section 6-5 (Gaming).

2. The purpose of these regulations is to ensure the honesty, integrity, fairness and good

character of the Colville Tribal Casinos and their employees, to protect the health,

safety, good order and general welfare of the people of the Colville Reservation and

the State of Washington, and to protect the public trust and the assets of the Casinos

and the Confederated Tribes of the Colville Reservation. 1.020

3. It is my responsibility to prove that I am qualified under these regulations. 2.010.3

4. I am responsible for payment of licensing fees. 1.060

5. A license is a privilege and not a right. 2.010.2

6. I have no vested property rights in a license and I cannot assign or transfer a license

issued to me. 2.010.2

7. A license is issued for no longer than 12 months and is subject to renewal

requirements. 1.030.1; 2.120

8. A license is issued for a specific position and may not be transferred to another

position. 1.030.1

9. I have the right to claim any privilege afforded by Colville law in refusing to answer

questions. However, if I choose to exercise this right, my refusal to answer questions

constitutes sufficient grounds for denial of a license. 2.020

10. It is my responsibility to be informed of Colville law and these regulations, currently

in effect or as they may be amended. My ignorance of these laws and regulations will

not excuse any violations and will not prevent appropriate prosecution, disciplinary

action or licensing sanctions, including revocation of my license. 2.010.7

By applying for license:

1. I authorize the Commission to obtain and to rely on information pertaining to my

eligibility to be an employee in Colville gaming operations. I understand that I do not

have a right to see or otherwise obtain or access such information. 2.010.4; 2.030.2

2. I consent to the jurisdiction and decision-making authority of the Colville Tribal

Gaming Commission. 2.010.5

3. I accept any risk of adverse public notice, embarrassment, criticism, or other action or

financial loss and I expressly waive any claim for damages as a result. 2.010.3

4. I agree to be bound by the laws of the Confederated Tribes of the Colville

Reservation in addition to the Colville Tribal Gaming Commission rules and

regulations and I specifically consent to the jurisdiction of the Colville Tribal court

system. 2.010.7

Revised: TGC 2024-153, 6-18-2024

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5. I agree to be bound by applicable laws and regulations of the United States and the

State of Washington. 1.010

6. I understand that the licensing process may also require approval by federal and/or

state agencies. 2.050

Temporary permit

If I am issued a temporary permit, I understand that this permit is subject to immediate

revocation for failure to successfully complete a background and financial investigation and

obtain a license. 2.080.2

Conditional license

If I am issued a conditional license, I understand the following:

1. I am responsible for complying with conditions placed on my license. 2.090.2

2. I am responsible for providing information required to address ongoing issues of

concern. 2.090.3

3. I am responsible for appearing before the Colville Tribal Gaming Commission before

the expiration of my conditional license and providing any information required to

address conditional issues. If I fail to do so, my conditional license will expire and

will no longer be valid. 2.090.4

4. If I fail to comply with my license conditions, my license may be suspended or

revoked. 2.090.5

Continuous duty to provide information

If I am issued a license or a permit, I have a continuing duty to provide the following information

to the Colville Tribal Gaming Commission: 2.110

1. Change of name, address, phone number or other licensing information.

2. Any occurrences which may reflect on my eligibility to be licensed under these

regulations.

3. Any act or failure to act which I believe would constitute a violation of these

regulations and/or Colville law.

Suspensions/Revocations

I understand that a license may be revoked or suspended for reasons deemed to be in the Tribal

or public interest and for any other reason authorized by applicable tribal, federal, or state law

and regulation. 3.010

Appeals

I understand that I may have the right to appeal licensing decisions to the Colville Tribal Gaming

Commission. In accordance with Colville Tribal law, I also understand that I have the right to

appeal a final decision by the Colville Tribal Gaming Commission to the Colville Tribal Court.

CTC 6-5 (Gaming).

Applicant Signature

Date

Print Applicant Name

Revised: TGC 2024-153, 6-18-2024

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Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

APPLICANT ASSURANCES

have received a copy of the

Noncriminal Justice Applicant’s Privacy Rights. I have read the Rights and I understand

them.

I acknowledge, accept, and understand the following:

1. I have been provided written notification that my fingerprints will be used to check

the criminal history records of the FBI.

2. If I have a criminal history record, the officials making a determination of my

suitability for the job, license, or other benefit must provide me the opportunity to

complete or challenge the accuracy of the information in the record.

3. I acknowledge that the procedures for obtaining a change, correction, or updating of

my criminal history record are set forth at Title 28, Code of Federal Regulations

(CFR), Section 16.30 through16.34.

4. I have the right to expect that officials receiving the results of the criminal history

record check will use it only for authorized purposes and will not retain or

disseminate it in violation of federal statute, regulation or executive order, or rule,

procedure or standard established by the National Crime Prevention and Privacy

Compact Council. (See 5 U.S.C. 552a(b); 28 U.S.C. 534(b); 42 U.S.C. 14616, Article

IV(c); 28 CFR 20.21(c), 20.33(d) and 906.2(d).)

5. I have been informed that the Colville Tribal Gaming Commission’s policy does not

permit us to provide you a copy of the record. You may obtain a copy of the record

by submitting fingerprints and a fee to the FBI. Information regarding this process

may be obtained at http://www.fbi.gov/about-us/cjis/background-checks.

6. If I decide to challenge the accuracy or completeness of my FBI criminal history

record, I should send my challenge to the agency that contributed the questioned

information to the FBI. Alternatively, you may send your challenge directly to the

FBI. The FBI will then forward my challenge to the agency that contributed the

questioned information and request the agency to verify or correct the challenged

entry. Upon receipt of an official communication form that agency, the FBI will make

any necessary changes/corrections to my record in accordance with the information

supplied by that agency. (See 28 CFR 16.30 through 16.34.)

Applicant Signature

Date

Print Applicant Name

Revised: TGC 2024-153, 6-18-2024

20 of 22

Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

COLVILLE TRIBAL CREDIT REPORT REQUEST

TO: Colville Tribal Credit

ATTN: John Smith Jr.

FAX #: (509) 634-4707

TITLE: Manager

Background use only:

DATE:

TIME:

FROM:

TITLE: Licensing Analyst

COMPANY: Colville Tribal Gaming Commission FAX #: (509) 422-7720

RE: Request for Colville Tribal Credit History

COMMENTS:

We are requesting a Colville Tribal Credit History print out for the following

person:

. (Fill In)

Clearly Print Full Name

Alias or Maiden Name:

(Fill In)

Please fax this information back to me at (509) 422-7720. If you have any

questions you may contact Backgrounds at tribal extension #7722, 7725, or 7726.

Date

(Fill In)

Revised: TGC 2024-153, 6-18-2024

Signature

21 of 22

(Fill In)

TOTAL NUMBER OF PAGES: 1

Colville Tribal Gaming Commission

729 Jackson Street, P.O. Box 1647, Omak, WA 98841

(509) 422-7722 / (509) 422-7725 / (509) 422-7726 / Fax: (509) 422-7720

COLVILLE TRIBAL COURT CRIMINAL HISTORY

REQUEST AND BACKGROUND INQUIRY

For Records Clerk only:

Information of person being cleared:

Name:

(Fill In)

Last

First

Middle

Alias or Maiden Name:

(Fill In)

DOB:

(Fill In) SSN:

(Fill In)

I hereby authorize the Colville Tribal Court Records Clerk to release any criminal history

maintained by your office to the Colville Tribal Gaming Commission’s Backgrounds

Investigator.

Date

(Fill In) X:

Signature

(Sign)

For Records Clerk only:

Record Clerk’s Signature:

DATE

Revised: TGC 2024-153, 6-18-2024

Date:

CHARGE

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DISPOSITION

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.