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Honeoye Falls Fire Department Background Check and Drug Testing Form

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Honeoye Falls Fire Department
Background Check and Drug Testing Form.


(Referred to herein as Employer)


Please take a moment to fill out the form and submit it.

As part of our normal procedure in processing applications, a routine inquiry will be made concerning your background. Former employers, school record offices and personal, school and employment references may be contacted by a consumer reporting agency to verify and obtain information concerning your background, qualifications, school and work records. You may be asked to sign another form authorizing the release of school records or to supply grade transactions. Information gathered about your background and qualifications will be used to help make a fair employment decision. The information will only be available to those participating in the decision or those who process employment applications. As part of the investigation, a check of original records will also be conducted by a consumer reporting agency. This agency may keep and use information it supplied to us in the investigation for its own business purpose. Further information such as the name of the consumer-reporting agency or the nature and scope of such inquiry, if one is made, is available to you upon written request. You will also be given a separate disclosure and authorization to review and sign concerning any reports' prepared about your background for us by a consumer reporting agency that compiled the report.

I hereby authorize the employer, its representatives, employees or agents to conduct all pre- employment inquires and tests as described. I further authorize the employer and its agents to verify all statements contained in this application and any other materials I submit in connection with my employment application. I agree to complete any requested authorizations forms. I release the employer, its agents and all providers of information from any liability arising out of the gathering and use of such information. In the event of employment, this authorization and release is valid throughout my employment and a photocopy is as effective as the original.

I understand the Village of Honeoye Falls has a policy requiring a Drug and Alcohol Free Work Environment. I understand that to complete my application for employment, I must provide the Village with the results of a drug test advising that I am drug and alcohol free. I agree to provide the Village with results of a drug test in order to complete my employment application. I agree to sign all authorizations and releases required to have the results of the drug test released to the Village. I understand if I am hired that a condition of my continuing employment, under certain conditions, will be to provide to the Village the results of a drug test and if I refuse it may be grounds. for termination of employment.

I understand all offers of employment are conditional upon satisfactory reference checks, successful completion of all pre-employment tasks and production of all documents necessary for the employer to verify my identity and work authorization in accordance with the recruitments of the immigration and Naturalization services.

As an employer, this organization is subject to Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Applicants who believe they are covered by these Acts are invited to identify their disabilities and special accommodations they feel are necessary to adequately perform their jobs. Submission of this information is strictly voluntary and may be made to the Human Resources Manager.

I certify the information provided in this application is true and complete to the best of my knowledge. I understand withholding pertinent information or submitting false or misleading information on this application, my resume, during interviews or at any time, during the hiring process constitutes valid grounds for disqualification from further consideration for hire or immediate dismissal from employment and loss of all employee benefits and privileges. I further understand and agree that the employer shall not be liable in any respect if my employment is so denied or terminated.

I understand the acceptance of this application by the employer neither expresses nor implies I will be offered employment. I understand my employment is at will and I may resign at any time for any reason; similarly, my employment may be terminated by the organization at any time for any reason. Any changes to this at will employment agreement will not be valid unless in writing signed by me and duly authorized representative of this employing organization.


I agree to undergo a physical and drug test.
It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of the application and/orfor separation from the HFFD service if I have been accepted.

Disclosure and Authorization Statement

In processing my application for employment, I understand the employer, its representatives, employees or agents may obtain a consumer report and investigative consumer report for employment purposes concerning my past employment, work habits, education, military record, motor vehicle record, credit background, references, character, general reputation, personal characteristics, mode of living, civil judgments, liens, and information about my criminal conviction background consistent with state and federal law.

I understand that upon written request to the employer, I will be informed whether an investigative consumer report through a consumer reporting agency was requested and I will be given information as to the nature and scope of the investigation and a summary of my rights under the Fair Credit Reporting Act. I understand an investigative consumer report is a report in which information concerning my character, general reputation, personal characteristics or mode of living is obtained through personal interviews with neighbors, friends, associates or others with whom I am acquainted or who may have knowledge concerning this information.


By signing below, I authorize this employer to obtain a consumer report and an investigative consumer report on me as part of the pre-employment background and investigation process. If I am offered employment, I further authorize my employer to obtain additional consumer and investigative consumer reports and updates on me for employment purposes at any time during my employment. A copy of this authorization is as valid as the original.


Thank you for your interest in joining the Honeoye Falls Fire Department.

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