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Pittsfield Charter Township conforms to the Immigration Reform and Control Act of 1986 which requires you to furnish documentation showing your identity and legal authorization to work in the United States once you have been offered employment.
Must be either a PDF or Word document
(Vocational, Trade, Graduate School, Professional Designation, etc.)
Please give an accurate, complete employment record. Start with current or most recent employer. This section must be completed fully, even if a resume is attached.
I HEREBY CERTIFY THAT I AM NOT CURRENTLY ENGAGED IN THE ILLEGAL USE OF DRUGS. I understand that as a condition of employment, I may be required to take a pre-employment drug test for the illegal use of drugs which may include the collection of urine samples from my person. I agree that the results of this test may be submitted to Pittsfield Charter Township or its authorized representative, and I expressly release the collection agency and the testing laboratory from any and all liability for performing the requested test, and for communicating the results to the Township. I understand that if the results of any pre-employment drug test are positive, it will be cause for rejection of my application or, if I am hired, that my employment with the Township may be immediately terminated.
• I certify that the answers and information given by me in this application are true, correct and complete without qualification. I understand that Pittsfield Charter Township has the right to refuse to hire or immediately discharge me, at any time, if it discovers that I have provided incomplete, untrue, or misleading answers or information in this application or on any other documents or forms submitted at any time during my employment.
• I hereby authorize Pittsfield Charter Township to verify the answers and information given by me in this application and to make any investigation on my background deemed necessary. I authorize former employers, law enforcement organizations, educational institutions, and any other third party contacted by the Township to release to the Township any information they have regarding me without providing written notice to me.
• I authorize Pittsfield Charter Township to use any information in its possession concerning me for any purpose it deems appropriate, including disclosure of information to any third party, future employer or prospective future employer without notification to me of such disclosure, and I release the Township from any liability in connection with such use or disclosure.
• If I am hired by Pittsfield Charter Township, I understand and agree that I will be bound by the rules, regulations, policies, procedures, and other terms and conditions of employment of the Township, as they are from time-to-time changed, with or without notice.
• If I am hired by Pittsfield Charter Township, I understand that I have the right to terminate my employment at any time and for any reason, with or without notice. I further understand that, except as set forth in any collective bargaining agreement, the Township can terminate the employment relationship at any time for any lawful reason, with or without cause, with or without notice. This employment relationship exists regardless of any other written statements or policies or any other Township document or any verbal statements to the contrary. No one except the Township Supervisor can enter into any kind of employment relationship or agreement which is contrary to the above. To be enforceable, any employment relationship or agreement which is contrary to the above must be in writing and personally signed by the Township Supervisor, and be attested by the Township Clerk.
• I agree not to commence any action or claim relating to my employment with Pittsfield Charter Township or this application for employment more than six (6) months after the date of the challenged action or this application, and to waive any statute of limitations to the contrary.
By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
This field is not part of the form submission.
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