Only the responses with asterisks need to be submitted. All Information will be kept CONFIDENTIAL!
Address
Phone Number Cell Number E-MAIL ****
Full Time Dealer Part Time Dealer On-Call Dealer Dual-Rate Dealer/Supervisor Slot Technician Cashier Keno Writer Simalcast Management Job Title **** How many years have you worked there?
EMPLOYER **** PARENT CO.
City State Zip Code
Would you like to see what's happening in Atlantic City happen where you work?YES NO Would you like to help organize dealers with the UAW where you work?YES NO