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An original application is required for each position.
Provide your employment history beginning with your present or most recent job. If you were self-employed, give firm name. Include any military or
volunteer work. Failure to give complete information regarding each job held may result in your disqualification. Complete addresses with zip codes
and phone numbers for all employers are necessary.
A resume may be attached only as additional information and will not be accepted in lieu of completing this section.
Check the boxes below only if you have experience with the software program for a minimum of 3 months.
If yes, please list.
Please answer the following when applying for a Public Safety position.
Please complete this section only if applying for a safety sensitive position.
I hereby acknowledge and understand that, as part of my application for employment for a position which involves the performance
of safety-sensitive functions as defined by 49 CFR Part 655, as amended, I must submit to a urine drug test under the authority of
the U.S. Department of Transportation, Federal Transit Administration. I acknowledge and understand that any offer of employment
is contingent on the passing of the aforementioned drug test and I will not be assigned to perform a safety-sensitive function unless
my urine drug test has a verified negative result having no evidence of prohibited drug use.
Your application will not be considered for employment of a covered safety-sensitive position unless this acknowledgement is
completed and signed.
In accordance with the Immigration Reform and Control Act of 1986, proof of authorization to be employed in the
United States will be required of all prospective employees. Failure to establish such proof will prohibit or
I certify that the information given in this application is true and complete to the best of my knowledge. I understand the
application is not a contract of employment. I further understand that should employment be offered, my employment and
compensation may be terminated with or without cause at any time by either the City of Jackson or myself and that my
employment is at will. I understand that submission of the application in no way assures me a position and that no city
representative has the authority to enter into any employment agreement with me contrary to the foregoing.
Employment with The City of Jackson is contingent upon successfully passing a medical and physical examination. I also
understand that if I am hired, I will be tested for alcohol and drug abuse and will be subject to random alcohol and drug
testing during my employment.
I understand failure to submit a complete application may disqualify me from consideration for a position.
I understand any untrue statement in the application may result in my dismissal at any time during my employment with The
City of Jackson.
I understand any information obtained in a personal history background investigation arising in whole or part, directly or
indirectly, from the waiver and authorization will be considered in determining my suitability for employment with The City of Jackson.
I authorize the release of high school and college transcripts, information concerning my previous employment and any
information my former employers may have pertinent to the application and the employment procedures of The City of
Jackson. I release all parties from all liability for any damage that may result from requesting, providing, processing, retaining
or releasing any information about me. A photographic copy of this authorization shall be as valid as the original.
I understand resumes, letters of reference, certificates, etc., submitted with the application become the property of The City
of Jackson and cannot be returned. The information I have provided on the application is subject to public disclosure under
the Georgia Open Records Act.
By signing this application, I hereby acknowledge that I understand and agree to all provisions outlined herein.
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