Citizen Potawatomi Nation

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Staff Dentist

Shawnee, OK • CPN Health Services

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Disclaimer for Gaming Applicants:

Authority: (U.S.C. Title 25, Ch.3, §E, Part 556)

The Citizen Potawatomi Nation Gaming Commission (Commission) is required by law to regulate and protect the integrity of the CPN gaming operations. The Commission shall investigate and license all applicants and licensees. To be employed by the CPN Gaming enterprises, you must apply for, obtain, and maintain a valid gaming license, including providing all appropriate documents within the timeframe specified by the Commission's Licensing Department.

Privacy Notice:

In compliance with the 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 by 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 Tribe 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 tribe or the NIGC in connection with the issuance, denial, or revocation of a gaming license, or investigations of activities while associated with a tribe or a gaming operation. Failure to consent to the disclosures indicated in this notice will result in a tribe's being unable to license you for a primary management official or key employee position.

The disclosure of your Social Security Number (SSN) is voluntary. However, failure to supply a SSN may result in errors in processing you application.

Notice Regarding False Statements:

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).

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