City of Bedford, Indiana



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Application for Employment
City of Bedford, Indiana

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.


Enter Application Information
Personal Information
Date:    
Applicant Name:
 
Last First Middle  
Present Address:
Street City State Zip
Permanent Address:
Street City State Zip
Email Address:
 
Phone Number:
Referred By:
 
Are you 18 Years of Age Or Older?

Employment Desired
Position
Date You Can Start:
v
Salary Desired
 
Are you Employed Now?
May We Contact Your Present Employer?
 
Ever Applied To This Company Before?
Where?
When?
 
Education
Name And Location Last Year Completed Field Of Study
Grammar School
v
High School
v
College
v
Trade/Vocational
v

General
  Subjects Of Special Study
  Related Skills (Drivers License, Typing, Etc...)
  Activities Other Than Religious (Civic, Athletic)
Exclude Organizations The Name Of Which May Indicate Race, Sex, Color Or National Origin Of Its Members

Employment History
(List Your Last Four Employers Starting With The Last One First)
Dates Name & Address of Employer Salary Upon Leaving Position Reason For Leaving
v
to
v
v
to
v
v
to
v
v
to
v
References
List Three Persons Below, Not Related To You, Whom You Have Known At Least One Year
Name Address Position Years Acquainted




Authorization
*"UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND AN APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT, ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100."
"IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT, AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALITIES AND CIVIL LIABILTIY.”
"IF YOU ARE TO BE HIRED BY THE COMPANY, YOU WILL BE REQUIRED TO ATTEST TO YOUR IDENTITY AND EMPLOYMENT ELIGIBILITY, AND TO PRESENT DOCUMENTS CONFIRMING YOUR IDENTITY AND EMPLOYMENT ELIGIBILITY, YOU CANNOT BE HIRED IF YOU CANNOT COMPLY WITH THESE REQUIREMENTS.”


Authorization

I certify that the facts contained in this application (and accompanying resume) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that my employment is conditioned on a complete background check. I hereby authorize the City of Bedford to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the City of Bedford, without giving me prior notice of such disclosure. I release the City, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contact. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the City of Bedford. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the City unless made in writing.

If I am offered employment, I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the City of Bedford and as permitted by law. I consent to such examinations and test, and I request that the examining doctor disclose the City the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the City’s Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate the City of Bedford to hire. If hired, I agree to abide by all company rules, policies and procedures, in whole or in part, at any time.



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Office of the Mayor Bedford City Hall
1102 16th Street
Bedford, IN 47421
DAndry@bedford.in.us