Village of Oregon is an Equal Opportunity Employer 3
Previous Employment (cont.)
May we contact your previous supervisor for a reference?
Authorization, Release, Certification and Signature
I certify that information on this application is true, complete, and correct, and I authorize investigation of the assertions I
have made to the Village of Oregon during this application process. Because of the importance to the public of the Village
hiring high quality candidates to serve the public’s interests with integrity and high ethical standards, I understand that any
false or misleading statement, omission, or misrepresentation concerning requested information on this application or
provided by me during the hiring process shall be a sufficient basis for rejection of my application or, if employed, my
I understand that my pursuit of employment may be contingent upon the satisfactory completion of any or all of the
following: interviews, skills or abilities testing, drug screening, background check, and investigation of my character,
personal history, work record and references, and medical examinations. I consent to this process including a post-
conditional offer pre-employment health examination and such future examinations as may be required by the Village.
I understand that I may be asked to sign a release and indemnification agreement regarding the background screening
process. I understand that I may negotiate the terms of that agreement and that I will not be considered for employment if
an agreement is not reached.
I understand this application will be considered inactive after thirty days unless otherwise decided by the Village.
I certify I have read (or have read to me) and understand this authorization and certification.
Please return application to: Oregon Area Senior Center
219 Park Street
Oregon, WI 53575
If you need an accommodation at any time during the recruitment or employment process, please inform us of your
needs. The Village of Oregon is an Equal Opportunity Employer and provides equal opportunities for all qualified
individuals. We do not discriminate against employees or applicants because of their age, race, gender, gender identity,
sexual orientation, religion, color, creed, national origin, veteran status, unemployment status, disability, or any other
classification regarded as protected under state or federal law.