The City of Franklin is hereby authorized to verify the information I have supplied and to conduct any investigation of my personal history. I also understand that any offer of employment may be conditioned upon the results of a medical examination. By signing below I also authorize the City of Franklin and it's assigns to perform a background check on all information provided by me on this application, including but not limited to, information related to pending criminal charges, past criminal convictions, and education and employment history. I further authorize any holder of information pertaining to the information supplied by me on this application to release such information to the City, which shall remain confidential pursuant to Wisconsin law. I understand and agree that the City shall not be held liable in any respect for any actions taken by the City to check such information.
It is the intent of The City of Franklin to comply with all state and federal requirements and to operate within the law in the implementation of all facets of equal opportunity and affirmative action. In the recruitment, selection, training, utilization, promotion, termination or any other personnel action, there will be no discrimination on the basis of race, color, religious belief, age, gender, sexual orientation, military service, national origin, citizenship status, disability, marital status, pregnancy, arrest of conviction record, or use or non-use of lawful products off premises. Do not include information of this nature in the application. It is The City of Franklin's intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.
I understand that should an employment offer be extended to me and accepted I will fully adhere to the policies, rules, and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
Applicant's Signature Date
CITY OF FRANKLIN
Voluntary Self-Identification Form
(CONFIDENTIAL - FOR STATISTICAL USE ONLY)
The City of Franklin is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by Federal, state or local law. The information below will be used only in the compilation of data for EEOC reporting.
PLEASE COMPLETE IN FULL:
Date: Position Applied for:
Sex: Male Female
Date of Birth: Applicant's Zip Code:
Ethnic Group: (Please check one of the descriptions below corresponding to the ethnic group with which you most identify.)
American Indian or Alaskan Native - A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian – A person having origins in any of the original peoples of the East, Southeast Asia or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
Black or African American – A person having origins in any of the Black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."
Native Hawaiian or Other Pacific Islander – A person having origin in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White – A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Hispanic or Latino - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, and of any race other than White.
Personal and Confidential - This document contains sensitive information and will be stored in secure files pertaining to EEOC reporting, separate from personnel records.