I, _________________________________, for and consideration of being considered for
employment by the Granville Police Department, do hereby make the following representation
and acknowledgements:
1. As part of the application process, I will have to take a physical agility test. The
process will consist of: 1. Upper body strength - complete eighteen (18) properly
executed push-ups within (1) minute. 2. Muscular endurance - complete twenty-eight
(28) properly executed sit-ups within (1) minute. 3. Aerobic power - complete a one
and a half (1.5) mile run with fourteen minutes and thirty-six seconds (14:36).
Regardless of physical condition, I recognize that there are risks of injury involved in
taking this physical agility test. I further understand that if I am not in appropriate
physical condition, I may be placing myself at risk. Any pre-existing injuries, diseases,
or physical conditions that may be aggravated by this test I have noted here:
________________________________________ . I hereby stated that I accept all risks and
responsibilities associated by this test.
2. I realize and agree that while taking this agility test, I am not an employee, agent or
servant of the Town of Granville or the Granville Police Department, and therefore will
not be covered by any worker’s compensation, death or disability benefits of the Town
of Granville.
By signing this waiver, I do hereby release and forever discharge the Town of Granville and/or
the Granville Police Department and its officials, officers and employees, in both their public
and private capacities, from any and all liability, claims, suits, demands or causes of action
that may arise from taking the agility test. This waiver is intended to cover all acts or
omissions of the Town of Granville and the Granville Police Department, officials, officers and
