9. Applicant’s Statement
I certify that answers given herein are true and complete.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and
obtain information from all references (personal and professional), employers, public agencies, licensing authorities
and educational institutions and to otherwise verify the accuracy of all information provided by me in this
application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the
employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory
information, in a lawful manner, in the employment process and all other persons, corporations or organizations for
furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application
is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis
prohibited by applicable local, state or federal law.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any
applicant wishing to be considered for employment beyond this time period should inquire as to whether or not
applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship
with this organization is of an “at will” nature, which means that the Employee may resign at any time and the
Employer may discharge Employee at any time with or without cause. This application does not constitute an
agreement or contract for employment for any specified period of definite duration. It is further understood that this
“at will” employment relationship may not be changed by any written document or by conduct unless such change is
specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of
the employer.
10. Authorization for Release of Personal Information
I do hereby authorize a review of and full disclosure of all records concerning myself to any duly authorized agent of the Nevada Public Safety Department whether the said records are of a public, private or confidential nature.
The intent of this authorization is to give my consent for full and complete disclosure of records of educational
institutions; financial or credit institutions, including records of loans, the records of commercial or retail credit
agencies (including credit reports and/or ratings); and other financial statements of records whenever filed; medical
and psychiatric treatment and/or consultation, including hospitals, clinics, private practitioners, and the U.S.
Veterans Administration; employment and pre-employment records, including background reports, efficiency
ratings, complaints or grievances filed by or against me and the recollections of attorneys at law, or of other
counsel, whether representing me or another person in any case, either criminal or civil, in which I presently have,
or have had an interest.
I understand that any information obtained by a personal history background investigation, which is developed
directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my
suitability for employment by the City of Nevada. I also certify that any person(s) who may furnish such
information concerning me shall not be held accountable for giving this information; and I do hereby release said
person(s) from any and all liability which may be incurred as a result of furnishing such information. I further
release the Nevada Public Safety Department and the City of Nevada from any and all liability which may be
incurred as a result of collecting such information.
I HEREBY SWEAR AND AFFIRM THAT EACH STATEMENT AND ALL INFORMATION IN OR
SUPPLEMENTING THIS APPLICATION (PERSONAL AND PHYSICAL EVALUATION) IS COMPLETE,
TRUE, AND ACCURATELY RECORDED TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT
PROVIDING FALSE, MISLEADING, AND/OR INCOMPLETE INFORMATION ON THIS APPLICATION IS
GROUNDS FOR EXCLUSION FROM THE SELECTION PROCESS OR DISCHARGE IF DISCOVERED
SUBSEQUENT TO EMPLOYMENT.
A photocopy of this release form will be valid as an original thereof, even though the said photocopy does not
contain an original writing of my signature.
