Revised November 2019
CITY OF GROTON AGREEMENT AND RELEASE
TO ALL APPLICANTS: PLEASE READ THIS SECTION CAREFULLY AND SIGNIFY YOUR UNDERSTANDING BY
SIGNING YOUR NAME IN THE SPACE INDICATED BELOW:
I certify that all of the statements made by me on this application for employment are true, correct, and complete to the best of my
knowledge. I understand that any falsification or material omission of fact on this application shall lead to refusal of employment or
dismissal from employment.
I authorize the City of Groton to check the references provided, and further authorize the investigation of all matters contained in this
application to verify its accuracy. I understand that all employment appointments are probationary, during which time I must
demonstrate my fitness for continued employment.
I understand that, as part of the application procedure for employment at the City of Groton, I will be required to submit to a urinalysis
test to detect the existence of drugs and other intoxicants. The test will be administered as required by State or Federal Law. I further
understand that, if the test is positive, I will be given a copy of the results, if requested.
I understand that as part of the application process, the City of Groton conducts thorough background checks (which may include a
check of my criminal history) and credit checks done on prospective employees. I agree, if contacted with respect to such background
check, that I will fully cooperate and provide any information requested.
The applicant is not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been
erased pursuant to Connecticut General Statutes Sections 46b-146, 54-76o or 54-142a. The applicant is not required to disclose the
existence of criminal records that are subject to erasure pursuant to Connecticut General Statutes sections 46b-146, 54-76o and 54-142a
which are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication
as a youthful offender, a criminal charge that has been dismissed or nullified, a criminal charge for which the person has been found
not guilty or a conviction for which the person received an absolute pardon, and the applicant is not required to disclose the existence
of criminal records that have been erased pursuant to Connecticut General Statutes, Sections 46b-146, 54-76o or 54-142a since the
applicant shall be deemed to have never been arrested within the meaning of the General Statutes with respect to these proceedings so
erased and may so swear under oath.
As a condition of employment I understand that information relative to the status of any driver’s duties, particularly insurability of a
driver by the City of Groton, is a vital job function.
As a condition of my employment, I hereby authorize my employer and its insurance agent to ask for and receive information relative
to the status of my motor vehicle operator’s license and motor vehicle history in every State in which I have held a motor vehicle
This authorization is valid from the date of my signature below throughout the term of my employment in which driving a City of
Groton motor vehicle is an essential job function.
I understand that if at any time (now or in the future) the City of Groton cannot insure me due to my motor vehicle operator history my
employment will be terminated.
AUTHORIZATION AND RELEASE
I hereby authorize all previous employers and references to release to the City of Groton, any and all employment and personnel
information requested, including, but not limited to my personnel file(s). I hereby also specifically release and hold harmless the City
of Groton, or any former employer and its employees and/or agents from any and all claims or liability as a result of releasing such
APPLICANT’S SIGNATURE DATE
(This employment application must be signed in ink or by electronic signature)
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