List name and telephone number of at least three references who are not related to you and are not previous
I certify that information contained in this application is true and complete to the best of my knowledge.
I understand that any misrepresentation of fact, as stated or implied, given in my application, interview(s),
or other employment forms will be sufficient reason not to hire me and may result in my discharge if I am
I authorize investigation of all statements contained in this application as may be necessary to arrive at an
employment decision. I hereby release from liability the Village of Niles and its representatives for
seeking, gathering or using such information and all other persons, corporations or organizations for
furnishing such information.
I understand that the Village of Niles is in no way obligated to provide employment and that I am in no
way obligated to accept employment with the Village. Nothing in this application is intended to create
any contract of employment, expressed or implied, or to create any rights to the nature of a contract of
employment. This application does not bind either party for a specific period of time regarding
employment. I understand that no representative of the Village of Niles, other than the Village Manager,
has the authority to make any assurances to the contrary. Any such assurances to the contrary by the
Village Manager must be in writing. If I am hired, nothing shall restrict my right as an employee to
terminate my employment at any time, nor shall anything restrict the right of the Village to terminate my
employment at any time at the option of the Village.
I also understand that, if hired, I am required to abide by all rules, ordinances, and regulations of the
Village. The Village policies and procedures relating to conditions of employment are subject to
modification by the Village without notice.
Signature of Applicant Date