GENERAL SERVICE WORKER 1

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• Read carefully and follow all instructions. Failure to follow instructions may result in disqualification.
• Completion of the Employment Application is required, even if you include your resume.
• If a deadline is posted, it applies to when the Application is received by the Human Resources Department, not the date mailed, completed, or submitted to any department other than Human Resources. Applications received by Human Resources after the deadline, regardless of postmark, will be kept on file for one year for eligibility for future openings of that position/test, but will not be eligible for the current position/test.

A Summary of Your Rights Under the Fair Credit Reporting Act

Personal Information

Employment Desired

You can find all open positions on our Job Opportunities page.

Education

High School

Undergraduate College

Graduate / Professional

Other (please specify)

Employment History

List below all present and part employes over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

Additional Information

List any languages other than English that you can speak, read or write that could be of benefit to the position applied for:

A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in question.

References

List below three persons not related to you who have knowledge of your work performance within the last 5 years.

Reference 1

Reference 2

Reference 3

Please read each statement closely and initial each acknowledging your understanding

Equal Employment Opportunity Statement

The City of D'Iberville is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The City desires to maintain a work environment that is free of sexual harassment and discrimination due to sex, race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The City will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Disclosure to Applicants Concerning Drug/Alcohol Testing

If you are offered a position with the City of D'Iberville, you will be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by the city. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment.

Complete and Accurate Information

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment

I understand and agree that if I am employed, my employment will be "at-will", which means that the City may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the City will respect my right to terminate my employment at any time, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the City unless made in writing and signed by the City Manager.

Testing Authorization

If offered a position with the City of D'Iberville, I hereby agree to any legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

Investigation Authorization

I authorize investigation into all statements and references contained in this application. Said investigation may include credit, driving, criminal background, references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving and criminal background.

Company Obligation

I understand and agree that the City's acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the City of D'Iberville is under no obligation to hire me as the result of accepting this completed application.

I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE City OF D'IBERVILLE.

City of D'Iberville, MS ("the Company") may obtain information about you from a third party consumer reporting agency for employment purposes. This information may be obtained in the form of a "consumer report" and/or an "investigative consumer report" (commonly known as a "background report"). These reports may contain information regarding your criminal history, social security verification, motor vehicle records ("driving records"), credit history*, verification of your education or employment history, drug screening or other background checks. This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses and educational institutions. The reports may also include information about your character, general reputation, personal characteristics, mode of living, etc., which can involve personal interviews with individuals or companies that you have listed as a reference, former employer, etc. A more comprehensive background investigation may be required pursuant to state or federal law, contract agreement or for certain sensitive positions (such as those with significant financial responsibilities). (*Please note that credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.)

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of any investigative consumer report obtained with regard to applicants for employment is an investigation conducted by Reference Services, Inc. (RSI). RSI is located and can be contacted by mail at 101 Plaza East Blvd, Suite 300, Evansville, IN 47715, and RSI can be contacted by phone at (800)881-0754. Information about RSI's privacy policy is available at the following link: http://www.referenceservices.com/wp-content/uploads/2013/09/RSI-Consumer-Information-Privacy-Policy.pdf. The scope of this notice and authorization is all-encompassing and allows the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment or your contract period to the extent permitted by law.