AUTHORIZATION
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the
best of my knowledge. I understand that any false statement, omission, or representation on this application is
sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the City of
Galva.
I understand that any employment is conditioned on a background check. I authorize the City of Galva to
thoroughly investigate all statements contained in my application or resume, and I authorize my former employers
and references to disclose information regarding my former employment, character and general reputation to the
City of Galva, without giving me prior notice of such disclosure. In addition, I release the City of Galva, any former
employers and all references listed above from any and all claims, demands or liabilities arising out of or related to
such investigation or disclosure.
I understand and agree that nothing contained in this application, or conveyed during my interview, is
intended to create an employment contract. I further understand and agree that if I am hired, my
employment will be "at will" and without fixed term, and may be terminated at any time, with or without
cause and without prior notice, at the option of either myself or the City of Galva. No promises regarding
employment have been made to me, and I understand that no such promise or guarantee is binding upon
the City of Galva unless made in writing.
If I am offered employment, I agree to submit to a medical examination and drug test before starting work. If
employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the City
of Galva and as permitted by law. I consent to such examinations and tests, and I request that the examining
doctor disclose to the City of Galva the results of the examination, which results shall remain confidential and
segregated from my personnel file. I understand that my employment or continued employment, to the extent
permitted by law, is contingent upon satisfactory medical examinations and drug tests, and if I am hired a
condition of my employment will be that I abide by the City of Galva's Drug and Alcohol Policy.
I understand that filling out this form does not indicate there is a position open and does not obligate the City of
Galva to hire. If hired, I agree to abide by all City of Galva work rules, policies and procedures. The City of Galva
retains the right to revise its policies or procedures, in whole or in part, at any time.
Date: Signature:
