I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment, and hereby release the City from any
claims, causes of action or liability arising out of any investigation conducted by the City. This application is considered to be
made for the position listed, and is not considered active after 45 days. Applicants seeking positions beyond this time period must
fill out an updated application.
I understand that the City may require criminal history checks, background checks covered by the Fair Credit Reporting Act,
and/or pre-employment drug testing. I acknowledge that such tests/investigations may be made and that employment is
contingent upon the results of such checks and tests.
I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT ALL EMPLOYEES OF THE CITY ARE
EMPLOYEES-AT-WILL WHO MAY QUIT AT ANY TIME FOR ANY REASON AND WHO MAY BE TERMINATED
AT ANY TIME FOR ANY OR NO REASON. NO ONE OTHER THAN THE CITY MAY MAKE ANY PROMISES OR
ASSURANCES OR ENTER INTO ANY CONTRACT, WHETHER ORAL OR WRITTEN, EXPRESS OR IMPLIED,
THAT IN ANY WAY IS CONTRARY TO OR INCONSISTENT WITH THE LIMITATIONS SET FORTH IN THIS
PARAGRAPH, AND ANY SUCH PROMISES, ASSURANCES, OR PURPORTED CONTRACTS SHALL BE INVALID
AND NOT BINDING ON THE CITY UNLESS ADOPTED, ENDORSED, OR AGREED TO IN WRITING BY THE
CITY ADMINISTRATOR AND APPROVED BY THE MAYOR.
In the event of employment, I understand that incomplete, false or misleading information given in my application or interview(s)
may result is discharge.
References
Name
Address
City, State, Zip Code
Telephone Number
Read Carefully and Sign
Signature of Applicant Date
Applicant's Statement
Note to Applicants: DO NOT ANSWER THESE QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE
REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the
job or occupation for which you have applied? _____ YES _____ NO
A review of the activities involved in such a job or occupation has been given. _____ YES _____ NO
Name
Address
City, State, Zip Code
Telephone Number
Name
Address
City, State, Zip Code
Telephone Number
Have you ever been convicted of a crime other than minor traffic offenses? _____ YES _____ NO
For purposes of this question, "convicted" includes a finding of guilty by a judge or court, pleas of nolo contendere or "no
contest", and guilty pleas. List details of every conviction, including date convicted, court, offense charged, and sentence imposed.
Date Convicted Court Offense Charged Sentence Imposed
click to sign
signature
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