Date: _________________________
Name: ________________________________________ I.D. Number: ___________________
Last First Middle
Department: ___________________________________ Division: ______________________
I understand that the __________________________________position I am accepting with
the _____________________________ department is an on-call position and as such requires
that I report to work, during an emergency situation, within the time required.
Therefore, I agree to maintain my place of residence within _________ miles and/or
________ minutes of my assigned work facility. If I am not in compliance with this
requirement, I understand that I have six (6) months to do so. I also understand that my
failure to comply with this requirement shall be cause for dismissal.
I understand that this agreement is not an employment contract and does not obligate me or the City to any
specific term of employment. I also understand that this agreement does in no way authorize me to travel at
speeds above the posted speed limit when I am requested to report to work during an emergency situation.
____________________________________________ _____________________________________________
Employee’s Signature Date Director’s Signature Date
Revised: November 2015
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