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Employment Application (Independence Public Library)

  1. 2018 City Logo

  2. Can you, after employment, submit verification of your legal right to work in the U.S.?

  3. Have you ever been convicted of a felony?

  4. Have you ever been in the armed services?

  5. Employment Desired

  6. Type of Position

  7. Are you employed now?

  8. If so, may we contact your present employer?

  9. Have you ever applied to the City of Independence before?

  10. Will you work overtime if needed?

  11. Education

  12. Former Employment

    Please list the most recent, first.

  13. Statement of Understanding

    I understand:
    - that completing this application does not constitute an offer of employment and that my application may be rejected for any reason.
    - that the statements made by me in this application and all related information which I have provided are true, accurate, and complete to the best of my knowledge. I also understand that if I provide false, inaccurate, or incomplete infor- mation, I will not be eligible for employment, or, if I am hired, I will be subject to disciplinary action or dismissal regardless of the date on which the City discovers the violation of its policy regarding dishonesty.
    - that I may be required to complete a medical history form and may be required to be examined by a medical professional designated by the City at the post- offer stage.
    - that the use of illegal drugs is prohibited during employment and that I may be required to undergo and successfully pass a screening for alcohol and/or drugs that is included in a post offer pre-employment physical examination. I also under- stand that, if extended an offer of employment, I may be required to submit to an alcohol or drug screening according to state law.
    - that if I sustain any injury or illness while in the employment of this organization, I agree that this organization shall be entitled to receive full and complete reports and records governing any medical or related examinations, and I authorize any and all such doctors, medical examiners, and hospitals to give this organization full and complete reports and records covering such examinations, condition, care, and treatment related to or resulting from the alleged illness or injury.
    - that this application will be considered only for the position I am applying for; if I wish to be considered for other positions, I must submit a new application for each position.
    - that this employment application and any other employee-related documents are not contracts of employment; and
    - that this organization follows an “employment at will” policy that an individual who is hired may voluntarily leave employment upon proper notice, and may be terminated by the employer at any time and for any reason.
    - that any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon by any prospective or existing employee.

    I agree to be responsible for public property and equipment issued to me by the City until returned by me. I agree to pay for property and equipment not returned and authorize the City to withhold an amount equal to value of property not returned by me from my final pay.

  14. Authorization to Release Information

    I authorize the City of Independence to make a complete investigation of me, including but not limited to, my past employment history, medical history, scholastic record, criminal activity, motor vehicle driving records, workers’ compensation history and to receive the results of any physical examination, including the results of alcohol or drug screening I maybe required to undergo, and to rely on such information sources. I understand that this organization may request an investigative consumer report from a consumer reporting agency that includes information as to mycharacter, general reputa- tion, and personal characteristics. I understand that the investigative consumer report may involve personal interviews with my neighbors, friends, relatives, former employers, schools, and others. I also understand that under the Federal Fair Credit Reporting Act, I have the right to make a written request to this organization, within a reasonable time, for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize all persons and organizations to release any information concerning my background and hereby release all persons and organizations from liability for any damage whatsoever for this information. I acknowledge that a telephone facsimile (FAX) or photographic copy shall be as valid as the original.

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