Human Resources444 4th StPort Arthur, TX 77640(409)983-8210
If yes, complete the following
If yes, provide the following information. Also include those that may not appear on record at this time.
When answering the questions below, include DWI and DUI charges or convictions. Do not include: 1) any violation of law committed before your 17th birthday, if the final decision was made in juvenile court or under a youth offender law; 2) any conviction whose record was expunged under Federal or State Law; 3) traffic violations, except DWI and DUI, as noted above.
The commitment of the City of Port Arthur to a policy of equal employment opportunity requires that certain information be gathered and maintained for statistical purposes only. Your cooperation in checking the options that apply to you would be greatly appreciated.
This information will not be used in any way in deciding who is recommended or selected for employment or for other personnel action.
IMPORTANT - CONDITIONS OF EMPLOYMENT - PLEASE READ CAREFULLY
I certify that my answers to the above are true and recognize that my future employment is subject to termination without notice should any of the above statements be found false or inaccurate regardless of the time that elapses before such false information is discovered. I hereby agree to submit to medical examinations (such examinations to include a drug screen) both as a condition of employment and as a condition of continued employment, to furnish proof of age and right to work in the U.S. (Birth Certificate,Visa, Etc.)
I understand that an investigative report may be made and hereby agree to authorize all persons, schools, companies, consumer reporting agencies and other organizations to supply any accurate information concerning my background. I further understand that I have a right to disclosure of such information reported, as provided by law. I understand and accept the conditions in this statement.
AT WILL EMPLOYMENT DISCLOSURE STATEMENT
“I understand that my employment and compensation with the City of Port Arthur can be terminated, with or without cause, and with or without notice, at any time, at the option of either the City or myself. I also understand that no employee or manager of the City of Port Arthur has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.”
DISCLOSURE AND RELEASE
In connection with my application for employment (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma and/or PublicData.com, Irving, Texas.These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from DAC/PUBLICDATA.COM concerning previous driving record requests made by others from such state agencies, and state provided driving records.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC/PUBLICDATA.COM TO FURNISH THE ABOVE-MENTIONED INFORMATION.
I have the right to make a request to DAC/PUBLICDATA.COM, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC/PUBLICDATA.COM has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC/PUBLICDATA.COM, and I agree that such information which DAC/PUBLICDATA.COM has or obtains, and my employment history with you if I am hired, will be supplied by DAC/PUBLICDATA.COM to other companies which subscribe to DAC/PUBLICDATA.COM Services.
I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
APPLICANT'S AUTHORIZATION AND INDEMNITY FOR THE CITY OF PORT ARTHUR TO DO BACKGROUND AND CRIMINAL INVESTIGATION
I am an applicant for employment with the City of Port Arthur, Texas (hereinafter called "City"). I understand that in order to evaluate my application for employment a Criminal and/or background investigation may be necessary. The information obtained from these investigations will be used solely in processing my application for employment and will become part of said application and, except as authorized by law, will not be released to anyone other than City Officials or employees.
By affixing my signature, and providing the information requested below, I affirm that I have read and understand this document in its entirety and agree to indemnify and hold harmless the City, its officers, employees and agents for all liability arising out of or resulting from the acquisition of information obtained as a result of these investigations. I authorize all persons, schools, companies, consumer reporting agencies, law enforcement agencies and other organizations to supply accurate information to the City concerning my background; and I agree to indemnify and hold harmless said persons and entities and their employees and agents for all liability arising out of or resulting from supplying said accurate information to the City. I further understand that I have a right to disclosure of the information reported, as provided by law. I understand and freely accept the provisions in this document.
I understand that a photocopy of this authorization shall be as valid as the original and shall be valid for the duration of my employment application.