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Proof of citizenship or immigration status will be required of all new employees upon employment.
Conviction will not necessarily disqualify applicant from employment
If not applicable, please check No.
Name and Address
You may exclude membership which would reveal gender, race, religion, origin, age, ancestry, disability, or other protected status.
Check skills you possess and list equipment you can operate
Do not answer the following question until you have read a copy of the job description explaining the essential duties of the position of which you are applying.
Start with your present or last job. Include military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements
contained in this application for employment as may be necessary in arriving at an employment decision. This application 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 understand and acknowledge, unless otherwise defined by applicable law, that all employment relationships with the City of Russell are “at will”, which mean an Employee may resign at any time with or without notice and the Employer may discharge an Employee at any time with or without cause and with or without notice. 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. I also understand that if I am employed by the City of Russell,
false or misleading information provided on my application or discovered during the course of an interview, may result in discharge. I further understand that if employed, I am required to abide by all rules and regulations of the City and recognize the residency requirement of living in Russell County within 6 months of hire date.
In connection with your application for employment, we may procure a Background Investigative Report and/or Background Report
on you as part of the process of considering your candidacy as an employee. In the event that information from the report is utilized
in whole or in part in making an adverse decision with regard to your potential employment, before making the adverse decision, we
will provide you with a copy of the consumer report and a description in writing of your rights under the federal Fair Credit
The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a summary of
these rights together with this document.
By your signature below you hereby authorize any present or previous employer to provide an authorized representative of the City
of Russell bearing this release, within one year of its date, any and all personal recollections and/or information in your files
concerning you, your character, general reputation, personal characteristics and personal history, including but not limited to
documents concerning your military service, employment credit history (including consumer records and/or credit ratings), financial
status, education and academic achievement, attendance, work performance, complaints or grievances filed by or against you,
background investigations, disciplinary actions, polygraph examinations, and any and all internal affairs investigations and discipline,
to include any files that are deemed to be of a private or confidential nature.
The information requested below is being used strictly for pre‐employment background screening purposes in order to obtain accurate results.
The consumer report may include, but not be limited to, criminal history, verifications of employment and
education, and driving records. A credit report detailing personal financial history will only be obtained for permissible purposes in consideration of jobs meeting specific criteria.
The EEOC states that for the purposes of pre-employment inquiries, under the Age Discrimination in Employment Act of 1967, Section 1625.5, "A request on the part of an employer for information such as "Date of Birth" or "State Age" on an employment application form is not, in itself, a violation of the Act"
The information requested above is used to assist in the completion of a background investigation. The information will be
maintained in a limited access file, detached from your application. The information will be used for the sole purpose of
identification when conducting a background investigation.
This field is not part of the form submission.
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