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Provide your employment history beginning with your present or most recent jobs. If you were self employed, give firm name; include any military or volunteer work. Failure to give complete information regarding each job held my result in your disqualification. Complete address with zip codes and phone numbers for all employers are necessary.

References should not be relatives.

I hereby acknowledge and understand that as a part of my application for employment for a position which involves the performance of safety-sensitive functions as defined by 49 CFR Part 655, as amended, I must submit to a urine drug test under the authority of the United States Department of Transportation, Federal Transit Administration. I acknowledge that any offer for employment is contingent on passing the aforementioned drug test.

In the event of an emergency, please contact the following person:

I certify that the information given in this application is true and complete to the best of my knowledge. I understand that this application is not a contract for employment. I further understand that should employment be offered, my employment and compensation may be terminated with or without cause at any time by either the City of Hampton or myself. I understand that submission of the application in no way assures me a position and that no City representative has the authority to enter into any employment agreement with the city to the foregoing.

Employment with the City of Hampton is contingent upon successfully passing a medical and physical examination (which will include a drug screening, provided at no cost to the applicant/employee).

I understand that failure to submit a complete application may disqualify me from consideration for a position.

I understand that any untrue statement in the application may result in my dismissal at any time during my employment with the City of Hampton.

I authorize the release of high school and college transcripts, information concerning my previous employment and any information my former employers may have pertinent to the application and the employment procedure of the City of Hampton. I release all parties from all liability for any damage that may result from requesting, providing, processing, retaining or releasing any information about me. A photographic copy of this authorization shall be as valid as the original.

I understand that resumes, letters of reference certificates, etc. submitted with the application become property of the City of Hampton and cannot be returned. The information I have provided on this application is subject to public disclosure under the Georgia Open Records Act.

I understand that disclosure of my Social Security Number on this application for employment is voluntary, that this information is solicited pursuant to the employer's policies and that it is intended to be used for the purposes of identification and tracking by the employment transactions.

By signing this application, I hereby acknowledge that I understand and agree to all provisions outlined herein, and that if hired, I understand that I will be on probation for a period of 1 year.

I hereby give my consent for the above agency to receive any Georgia or other criminal history record information pertaining to me, as authorized under state and federal law for individuals seeking employment with a criminal justice agency.

I hereby authorize the above agency to receive a copy of my Georgia driver's history information as part of my application for criminal justice employment or for use relative to the performance of my official duties with this agency.

I hereby authorize a review of and full disclosure of all records concerning myself to any duly authorized agent of the Hampton Police Department, whether the said records are of a public, private or confidential nature.

The intent of this authorization is to give my consent for full and complete disclosure of the records of educational institutions; financial or credit institutions, including records of loans, the records of commercial or retail credit agencies (including credit reports and/or ratings), and other financial statements and records wherever filed; medical and psychiatric treatment and/or consultation, including hospitals, clinics, private practitioners and the U.S. Veteran's Administration; employment and pre-employment records, including internal investigative reports, background reports, polygraph reports and charts; efficiency rating complaints or grievances filed by or against me; and the records and recollections of attorneys-at-law or the counsel; whether representing me or another person in any case, either criminal or civil, in which I presently have or have had an interest; and any other document or article of information or opinion deemed pertinent for the purposes of assessing my suitability for employment.

I understand that any information obtained by a personal history background investigation which is developed directly or indirectly, in whole or in part, upon this release authorization will be considered in determining my suitability as a candidate for employment by the City of Hampton. I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information; and are released from any and all liability of any kind of nature including but not limited to, defamation (libel and slander) related to my references and background checks.

A photocopy of this release from will be valid as an original thereof, even though the said photocopy does not contain an original writing of my signature.