CERTIFICATION
I certify that the information given by me on this application is true and correct without omissions to the best of my knowledge. I understand and agree that any misrepresentations or deliberate omissions of fact during the application/hiring process may result in a rejection of my application, or if employed, a termination from employment.
I further understand that the County will make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers, or oral interviews. I consent to and authorize information requested by the County or its agents and I release from liability any person giving or receiving any such information.
I understand that due to business needs, it may be necessary at times for management to mandate overtime. I understand this is within management's rights as dictated by the needs of the County.
I further understand that Price County has adopted a Drug Free Work Environment that requires that all candidates for employment undergo a drug-screening test prior to appointment.
CONFIDENTIAL INFORMATION RELEASE AUTHORIZATION
INDIVIDUAL WHO IS SUBJECT OF RECORD |
INFORMATION RELEASED TO |
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Price County |
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Human Resources Department |
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Price County Courthouse |
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126 Cherry Street |
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Phillips, WI 54555 |
SPECIFIC RECORDS AUTHORIZED FOR RELEASE
1.Present employer(s)
2.Former employer(s)
3.Any school, college, university, or other educational institution
4.Personal references
PURPOSE OR NEED FOR RELEASE OF INFORMATION
As evidence of my desire to obtain a position with Price County, I hereby authorize any official representative of Price County, bearing this release, to obtain information and records pertaining to me and my qualifications whether such information is public, private, or confidential in nature from any or all of the above sources. I understand that the above information is necessary for determining my eligibility or suitability to obtain employment with Price County. I hereby release any individual or institution, including its officers, employers, or related personnel, both individually or collectively, from any and all liability from damages of whatever kind, which may at any time result to me, because of compliance with this authorization and request to release information or any attempt to comply with it. A photocopy of this release will be valid as an original thereof.
As evidenced by my signature below, I hereby authorize disclosure of records to the person(s) or agency(s) as specified above.
Signature of individual who is subject of record |
Date signed |
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