Background Check Authorization
I have made application for employment with the City of Ellsworth, Maine and understand that in order to assess my qualifications a full background investigation is necessary. Certain positions may also be conditioned on the successful completion of agility tests, skill evaluations, additional investigations and/or the ability to be bonded. I therefore authorize the City of Ellsworth to conduct an investigation which may include but not be limited to:
• Verification of information provided by me to the City during the application process.
• Contacting employers (past/present), clients, business associates, professional organizations, or other institutions, regarding work performance and character.
• Verification of licensure and/or educational attainment.
• Criminal background check.
• Credit check.
• Driver’s license check.
I certify that all the information and materials I have provided to the City of Ellsworth as part of the employment process are accurate and truthful. I realize that providing the City with false information or intentionally withholding relevant information regarding my application may be grounds for rejection or dismissal. If employed, I agree to provide proof of identity, relevant licensure or credentials, and authorization for employment in the United States. Upon employment, I agree to abide by all municipal policies, regulations, ordinances and established work safety practices.
I hereby agree to hold harmless and to release the City of Ellsworth, including its officers and employees or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization to conduct a thorough background investigation. Name
Previous Addresses or Cities lived in within past 10 years Signature
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By signing, I authorize the above employment background check.