* - indicates a required field

I acknowledge that the information provided in this application for employment is true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I authorize investigation of all statements contained in this application and the release of any pertinent information regarding my education, past employment history and background. I authorize the Town of Burlington to obtain any information from schools, employers or individuals relating to my activities. This information may include, but is not limited to: academics, achievement, performance, attendance, personal history and discipline. Further, I hereby authorize all references, persons, schools, my current employer (if applicable) and previous employers and organizations named in this application, unless otherwise stated, to provide the Town of Burlington any relevant information that may be required to arrive at an employment decision. I understand that the information released is for the Town of Burlington's use only.

I hereby voluntarily release, discharge and exonerate the Town of Burlington, its agents and representatives, and any person so furnishing information from any and all liabilities of every nature and kind arising out of the furnishing or inspection of such documents, records and other information or the investigations made by or on behalf of the Town of Burlington.

I understand that all appointments are probationary and that I must demonstrate my ability for continued employment. I also understand that I must be available from time to time to work outside normal business hours, as the needs of the department require. In the event of my employment with the Town of Burlington, I will comply with all rules, regulations, and policies set forth in the Town of Burlington's Personnel Rules & Regulations or other communications distributed by the Town of Burlington.

I agree to sign a Criminal Offender Record Information Release form and further authorize the Town of Burlington to conduct background checks that they deem necessary for evaluating your application for employment, and to obtain a report from a consumer reporting agency to be used for employment purposes in accordance with the Fair Credit reporting Act. If required for the position I am seeking, I agree to take a physical examination, which may include testing for drugs or a psychological examination, as required, and recognize that any offer of employment may be contingent upon the results of such an examination.

I understand that any employment offer by the Town is conditional upon my ability to establish employment eligibility under the Immigration Reform and Control Act of 1986 within three days of the date of hire.

I understand that employment with the Town of Burlington is "at will" which means that either you or the Town of Burlington can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statue or agreement. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Town of Burlington has any authority to alter the foregoing.