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(If different than current address)
Please list all instances in which you were convicted and pleaded no contest as an adult for crimes (misdemeanors or felonies), ordinance violations, traffic violations and the like. Also, please list all criminal charges (misdemeanors or felonies) currently pending against you. Failure to include all information requested under this section may result in denial of employment.
A conviction record or pending arrest record does not constitute an automatic bar to employment and will be considered only if there is a substantial relationship to the circumstances of the particular position or if the employer deems there is a bona fide occupational qualification inherent in the position which requires this information prior to hiring.
College or university, technical, nursing, business college or other schools you have attended.
You must complete the employment sections of this application. Use additional sheets if necessary. You may
attach a resume to further explain your qualifications. Please list a minimum of prior ten year’s experience and education.
No relatives/significant others.
Please read and initial each of the following statements. If you have a question regarding any of these statements, ask a Village Hall representative prior to initialing and signing the application. Your initials and signature verify that you have read, understand and agree to abide by these statements.
I authorize any person contacted to provide the Village of Whitefish Bay any and all information regarding my employment, education and other information concerning any of the subjects covered by the application which may include, but not be limited to, application of employment, performance evaluations, work records, excluding workers compensation if any, wage rates, supervisors’ comments, results of any and all non-medical tests, disciplinary reports or letters, and complaints or allegations regarding any misconduct. I agree to execute release authorization forms as required by the Village of Whitefish Bay to request employment records from my present and/or former employer(s). I release and hold harmless the Village of Whitefish Bay, their officers, agents and employees, and the person(s) providing the information from any liability related to the providing of this information.
I understand that after receiving a conditional offer of employment I may be required to successfully pass pre-employment and post-employment exams to gain employment or continue employment with the Village of Whitefish Bay. I consent freely and voluntarily to participant in required drug tests and/or a pre-employment physical exam at a location selected by the Village of Whitefish Bay, and consent to the release of the test results to the Village of Whitefish Bay. I hereby release and hold harmless the Village of Whitefish Bay, their officers, agents and employees, and the laboratory, their employees, agents and contractors from any liability whatsoever, arising from the drug tests and/or a pre-employment exam and decisions concerning employment based upon the results of the tests.
I authorize the Village of Whitefish Bay, its officers, agents, and employees to conduct a background criminal check and a check with the Department of Transportation prior to making a decision regarding employment. I release and hold harmless the Village of Whitefish Bay, their officers, agents, and employees and the person(s) providing the information from any liability related to the performance or result of this check. I recognize that this information will be considered by the Village of Whitefish Bay only if it substantially releases to the position applied for.
If accepted for employment, I agree that my status as an employee depends upon my successful performance. I understand that just as I am free to resign at any time, the Village of Whitefish Bay reserves the right to terminate my employment at any time. All employees not covered by a collective bargaining agreement are considered at-will employees.
I agree to use such personal protective equipment and devices as may be required by the Village of Whitefish Bay and to comply with safety rules and requirements. In addition, I understand that the Village of Whitefish Bay maintains a workplace free from drugs, harassment and violence.
I understand that nothing contained in the application or any employee handbook, the granting of an interview, or an offer/acceptance of employment constitutes an employment contract. I understand that no representative of the Village of Whitefish Bay has the authority to make any assurances to the contrary.
I hereby certify that all statements made on or in connection with my application are true, complete and correct to the best of my knowledge and belief. I understand and agree that any misstatements or omissions of material fact subject me to disqualification or, if hired, dismissal.Notice – Wisconsin Open Records Law: Under Section 19.36(7) of Wisconsin Statutes, the names of the “Final Candidates” must be open to public inspection. The statute also provides that if an applicant does not want his/her name revealed prior to being a “Final Candidate” they can do so by making a separate request in writing.The Village of Whitefish Bay is committed to the equality of opportunity for all people. It is the policy of the Village of Whitefish Bay to provide equal employment opportunities for all individuals on the basis of their skills, abilities and qualifications, without regard to race, color, national origin, religion, political affiliation, sex, age, disability, marital status, arrest or conviction record, sexual orientation, disabled veteran or covered veteran status, membership in the National Guard or any other reserve component of the United States or State military forces, use or nonuse of lawful products off the employer’s premises during non-working hours, or any other non-merit factors, except where such factors constitute a bona fide occupational qualification.
By typing your name into this field you authorize the village to consider this an electronic signature.
This field is not part of the form submission.
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