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Specify which test you are applying for. If you're interested in taking both, list both as job applying for.
Social Security Card,
High School Diploma,
TWO Copies of High School AND College Transcripts, and
Any Training Certificates
List name, addresses, and telephone of three persons as personal references. (Do NOT List Relatives)
As a condition for my application being considered, I understand and agree to submit to a urine drug test for illegal substances. I recognize that in no way shall this test be used to screen out individuals taking legal medications. I understand that if my test results are positive for illegal substances, I shall not be considered further by the City of Natchez for employment.
I hereby authorize any certified medical facility to conduct such testing and to provide the results to the City of Natchez. I release the City of Natchez from ALL liability which may arise or result from the aforementioned drug test.
I voluntarily consent to authorize the City of Natchez or any of its officers, employees, or agents to check my references by contacting any person or entity whom they deem to be an appropriate reference. I understand that questions may be asked about my educational background, work experience, achievements, wage history, performance, attendance, personal history, character, personality, disciplinary information, and reason for separation from former employment.
It is expressly understood that any information given is to be used for the purpose of determining my acceptability for employment with the City of Natchez.
I also hereby release the City of Natchez from all liability for damages or claims - including, but not limited to, defamation, interference with contract, and negligence - which may arise or result from any reference information gathered pursuant to this authorization.
I respectfully request and authorize you to furnish the City of Natchez/Civil Service Commission any and all information that you may have concerning my work record, military record, reputation, and criminal background. This information is to be used to assist the City in determining my qualifications and fitness for the position for which I am seeking with the City of Natchez. I hereby release you, your organization and others from liability or damage which may result from furnishing the information requested above.
By signing this Electronic Signature Acknowledgment, I agree that my
electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
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