Casino Control (Burswood Island) (Licensing of employees) Amendment Regulations 1997 (WA)
| 7288 | GOVERNMENT GAZETTE, WA | (12 December 1997 |
| RA301 | ||
| CASINO CONTROL ACT 1984 |
CASINO CONTROL (BURSWOOD ISLAND) (LICENSING OF
EMPLOYEES) AMENDMENT REGULATIONS 1997
Made by the Lieutenant-Governor and deputy of the Governor in Executive
Council.
Citation
suspension to be forwarded to the Operator. 1. These regulations may be cited as the Casino Control (Burs wood Island)
(Licensing of Employees) Amendment Regulations 1997.
Principal regulations
2. In these regulations the Casino Control (Burswood Island) (Licensing of
Employees) Regulations 1985* are referred to as the principal regulations.
f* Published in Gazette 16 August 1985, pp. 2905-16.
For amendments to 4 November 1997 see 1996 Index to
Legislation of Western Australia, Table 4, p. 311
Regulation 15 amended
3. After regulation 15 (1) of the principal regulations the following
subregulation is inserted —
<I
(1a) If the Commission cancels, or suspends the operation of, a
licence, the Commission shall cause notice of the cancellation or
12 December 19971 GOVERNMENT GAZETTE, WA 7289 Regulation 19 amended
4. Regulation 19 (4) (a) of the principal regulations is amended by deleting
"6 weeks" and substituting the following -
ci 3 months ".
Schedule amended
5. The Schedule to the principal regulations is amended by deleting Form 1
and substituting the following form -
44
S]Th Ii (Regulation 4)
CASINO CONTROL ACT 1984
CASINO CONTROL (BURSWOOD ISLAND) (LICENSING OF EMPLOYEES) REGULATIONS 1985
CONFIDENTIAL
APPLICATION FOR LICENCE AS A CASINO KEY EMPLOYEE OR
CASINO EMPLOYEE
IMPORTANT NOTICE
Failure to give a true, correct and complete answer to any question in this application form may result in a refusal of the licence application and may make you liable to conviction of an offence under section 29 of the Gaming Commission Act 1987. A person who makes a declaration that, in any material particular, is to the person's knowledge false, is also liable to be convicted of an offence under section 170 of The Criminal Code.
This application form must be signed and dated by the applicant at the foot of each page.
Information provided in this application will be treated
CONFIDENTIALLY.
PART 1— TYPE OF APPLICATION
I, being a person over the age of 18 years, apply for a licence as -
(a) a casino key employee*; or (b) a casino employee*,
at the Burswood International Resort Casino to perform the following
type(s) of work:
Signature of Applicant Date
Note: dates should be entered
in the following format -
Day/Month/Year
* Delete as necessary.
| 7290 | GOVERNMENT GAZETTE, WA | [12 December 1997 |
PART 2— PERSONAL INFORMATION
All questions must be answered. If a question does not apply to you, write Not Applicable or N/A in response.
(a) Photographic Identification: Date of photograph: ......./ ......./ .......
I certify that this is a true resemblance of:(name of applicant)
whom I have known for ..................years.
(signature of person certifying identity of applicant)
3 x Passport Photographs
(attach with
pins)
Back of each photograph
must be signed by person
certifying applicant's
identity.Name, address, and telephone numbers of person certifying identity of applicant, and relationship to applicant:
(b) Legal name(s): Male 0 Female 0
(surname/family name) (first name) (middle name(s))
(c) Other names: include any maiden name, nickname, aliases and other names (legal or otherwise) that you have used or by which
you have been known. If your name has changed from birth, please provide documentary evidence of name change, such as a marriage certificate, deed poll or licence.
(d) Date of birth: (e) Place of birth:
(city) (State) (country)
(f)
If you were born overseas, the date of your arrival in Australia.......................................
(g)
Residential address: Home telephone:( ) ........ Mobile telephone............
(number) (street) (posteode)
(h) Do you hold a current motor vehicle driver's licence?
Yes [3 No 1-1
12 December 19971 GOVERNMENT GAZETTE, WA 7291 If yes, please provide licence number and State or Country of issue and expiry date:
(i) Employment details:
Current occupation. ..................................
Employer's name. ...................................
Employer's address: work telephone:( ) ...........
(number) (street) (postcode)
Provide complete details of your work history, including, if applicable, periods of unemployment, schools or colleges attended
and all businesses with which you have been involved in the last
5 years:
Month and year Name, address of Position held Name of Reason (from - to) employer/business supervisor for and tel. leaving or fan nos. Have you ever been retrenched, dismissed, discharged or requested to resign from any employment?
Yes No
If yes, provide the employer's name and address and the reasons for your dismissal, resignation, etc:
(j) Have you ever served in the armed forces? If yes, while in the armed forces were you ever charged with an offence that resulted in a court martial or other disciplinary action against you?
Yes 11 NoD
If yes, please provide details:
(k) Physical description: Height: (cms) ................ Weight (kgs)
Colour of eyes: Blue 0 Green G Brown 13 Hazel 0 Other. . .
| 7292 | GOVERNMENT GAZETTE, WA | [12 December 1997 |
Colour of hair: Fair 0 Brown 0 Auburn 0 Red 0 Black 0
Other D.
Complexion: Fair 0 Ruddy 0 Medium 0 Dark 0 Other.
Do you have any scars, tattoos or other distinguishing markings?
Yes D No
If yes, please provide details:
PART 3— MARITAL INFORMATION
(a) Marital status:
Married 0 Single 0 De facto 0 Separated 0 Divorced 0 Widow(er) 0 If applicable:
Spouse/De facto's full name............................
Spouse/De facto's alias(es)..............................Spouse/De facto's maiden name..........................
PART 4— RESIDENCES
List ALL addresses at which you have been a permanent resident for a period of 6 months or more over the last 5 years:
Month and year
(from - to)Number, street, city State Country
PART 5— PASSPORT AND TRAVEL INFORMATION (a) Do you have a current passport? Yes 0 No
If yes, please provide the following:
Passport. number ................................... Country of issue. ....................................
Place of issue.......................................
Date of issue:Date of expiration....................................
(b)
If you are normally resident in Australia, have you travelled out of Australia during the last 3 years?
Yes 0 No
12 December 19971 GOVERNMENT GAZETTE, WA 7293 If yes, please provide details:
Date of Date of Period Countries Reasons for departure return overseas visited travel
PART 6— RECORD OF CRIMINAL OFFENCES AND
CIVIL CLAIMS
(a) Have you ever been convicted of any offence whatsoever (whether or not resulting in a fine), either in Western Australia or elsewhere?
Yes DNoD
If yes, please provide details:
Nature of
offenceAge at time Date and Full name Sentence of offence place of under imposed conviction which
convicted
IMPORTANT IN RELATION TO EVERY APPLICATION FOR A CASINO EMPLOYEE LICENCE OR CASINO KEY EMPLOYEE LICENCE, THE GAMING COMMISSION MAKES INQUIRIES TO ESTABLISH WHETHER THE APPLICANT HAS HAD ANY INVOLVEMENT WITH LAW ENFORCEMENT AGENCIES. FAILURE TO DISCLOSE ANY SUCH INVOLVE31ENT WILL BE TAKEN INTO ACCOUNT IN ASSESSING YOUR CHARACTER, HONESTY AND INTEGRITY.
(b) civil proceedings against you may be pending? Do you have any reason to believe that any criminal or
Yes DNoD(c) Have you, or has a business with which you are or were associated, ever been the defendant in any civil action?
Yes DNoD
(d) Have you ever had a civil judgment or decision entered against you?
Yes IJNoD
| 7294 | GOVERNMENT GAZETTE, WA | [12 December 1997 |
(e)
Has or have your salary, wages, earnings or other income been subject to a garnishee order or attachment or anything of that nature?
Yes DNoD
(f) Have you ever had any article repossessed, whether by a finance company or otherwise? If you answered yes to any of the above questions, please provide full details below or in an attached document. You may also wish to attach photocopies of any documents you may have relating to the details you provide.
PART 7— GAMING EXPERIENCE
(a)
Have you ever been excluded, for any reason, from a casino either in Australia or overseas?
Yes 0 No
If yes, please provide details............................
(b)
Have you ever been excluded, for any reason, either in Australia or overseas from a place (other than a casino) where gaming or racing has been conducted?
Yes D No E3
If yes, please provide details............................
(c)
Provide brief details of any experience you have had in the casino/gaming industry.
(d)
Have you ever been employed, either in Australia or overseas, by a casino regulatory authority or a gaming regulatory authority?
Yes D No
If yes, please provide details:
Jurisdiction Position Brief description of duties
12 December 19971 GOVERNMENT GAZETTE, WA 7295
(e) Do you hold, or have you ever held, any casino employee licence or gaming operator's licence, in Australia or overseas?
Yes 0 No
If yes, please provide details . ...........................
Licence type and number Jurisdiction Licence type and number Jurisdiction Licence type and number Jurisdiction
(1) Have you held any licence specified above that has been -
(i) cancelled; (ii) suspended; or (iii)
made subject to any conditions as a result of disciplinary action?
Yes IJ No
If yes, please provide details ...........................
(g)
Have you ever withdrawn an application for a casino employee licence?
Yes ONoD
If yes, please provide details ...........................
(h) Have you ever had an application for a casino employee licence refused?
Yes 11 No D
If yes, please provide details ........................... PART 8— CHARACTER REFERENCES
Nominate 3 persons who -
(a) are not related to you; (b) and do not work at the Burswood International Resort Casino;
| 7296 | GOVERNMENT GAZETTE, WA | [12 December 1997 |
(c) have known you for a reasonable period, preferably during the last 5 years.
Referees nominated by you may be asked to appraise your character and reputation. Please inform your referees that you have nominated them in this application form.
1. Title: Dr 0 Mr 0 Mrs 0 Ms 0 (please tick appropriate box) Name............................................
Address...........................................Telephone. .........................................
2. Title: Dr D Mr 0 Mrs 0 Ms 0 (please tick appropriate box) Name. ............................................
Address. ...........................................Telephone. .........................................
3. Title: Dr D Mr D Mrs 0 Ms 0 (please tick appropriate box)
Name: ............................................ Address. ...........................................
Telephone: .........................................
PART 9— STATUTORY DECLARATION AND INDEMNITY
Before completing this declaration, you should read again the notice at the beginning of this application form relating to knowingly making a false declaration.
I......................................................
(Full (printed) name of applicant)
of ....................................................
(Residential address) (Occupation)
do solemnly and sincerely declare that -
(a) I am the person identified in Part 1 of this form; (b) the information provided in it and attached to it (other than the certification of my identity in Part 2 (a)); I have personally completed this form and have supplied all
(c) the information provided in this form or attached to it is true and correct in every detail and fully discloses the
material required to complete this form;
any document attached to or accompanying this form that
(d) is not an original document is a true copy of the original document; and
(e) for me, my heirs, executors, administrators, successors and assigns, I -
(i) release and discharge; and
(ii) of negotiation in relation to, or defending or settling, indemnify (including indemnify in respect of the costs
any action, proceeding, claim or demand),
12 December 19971 GOVERNMENT GAZETTE, WA 7297 the Government of Western Australia, the Gaming Commission of Western Australia, the Commissioner of Police and any of them, and their respective agents, employees and informants, from and against all or any manner of actions, proceedings, claims, demands, losses, costs and expenses whatsoever, in law or equity and in all by reason of the processing or investigation of, or from jurisdictions, whether arising directly or indirectly out of or
matters relating to, this application, including inquiries whether made before or after the issue of the licence applied for or continuing inquiries, and whether or not attributable in whole or in part to any negligence,
and, having read and understood this declaration and indemnity, I execute them voluntarily, and I make this solemn declaration by virtue of section 106 of the Evidence Act 1906.
Declared at ) this ) day of ) ) 19 )
before me ) Signature of Applicant Commissioner for
Declarations or
Justice of the Peace(or as the case may be) (Signature of Witness)
PART 10— AUTHORIZATION TO MAKE INQUIRIES
For the purposes of this application, I authorize the Gaming Commission of Western Australia to cause whatever inquiries are considered by the Commission to be necessary to be made, in the State of Western Australia and elsewhere, to verify the information provided by or concerning me, and that such inquiries may be made both before and after the issue of the licence.
For the purposes of this application, I authorize —
(a)
the manager or officer in charge of any bank or other financial institution to whom a request is presented by an accredited representative of the Gaming Commission of Western Australia, or a police officer, to allow the representative or officer to inspect and obtain copies of, or extracts from, any documents, records or correspondence relating to me, whether solely or jointly with any other
person, including any credit or loan information, cheque account records, savings, credit and passbook records, safe deposit records, and statement sheets held by that bank or
financial institution; and(b)
the Commissioner of Police, and any police officer in the State or elsewhere acting at the request of the Commissioner of Police, to inquire into, record and report to the Gaming Commission of Western Australia any known or suspected criminal activity, associates, antecedents or circumstances concerning my suitability for employment in the Burswood International Resort Casino.
Signature of Applicant Date
(Full (printed) name of applicant)
By Command of the Lieutenant-Governor and deputy of the Governor,
M. C. WAUCIIOPE, Clerk of the Executive Council.
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