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*Note: You are not obligated to discuss sealed or expunged records of conviction or arrest nor will such information be asked of you or considered in
employment decisions. The existence of a criminal record will not automatically disqualify you from the job for which you are applying.
List any training beyond high school. College or university, nursing, business college, tech college or other schools you have attended.
List three persons who are not related to you and who would have knowledge of your
qualifications for the position(s) for which you are applying.
List your past three work experiences (paid or volunteer) starting with the most recent.
Please list any other certifications and/or qualifications you possess that are not previously listed in this
Applications will be kept until the position has been filled. Your application may be kept longer in our files for
future reference if additional positions become available.
I certify that all statements on my application materials are true to the best of my knowledge. I understand that
misrepresentation of material omission made by me on this application will be sufficient cause for cancellation of this
application or immediate discharge from the employer’s service.
I give the employer the right to contact and obtain information from all references, employers, educational institutions and to
otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and
its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for
furnishing such information.
I understand and agree that if employed, the employment will be “at will”. That is, either I or the Village may end the
employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by the
Village does not imply employment and that this application and/or any other Village documents are not contracts of
By my signature below, I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Last, First, Middle, Maiden
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 responsibilities 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 hearing.
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.
I realize that during the processing of my application, my background as it relates to this job,
will be investigated by the Village of Howard. I understand that any information concerning my
past will be considered in evaluating me as an applicant to the Village of Howard and that all
information obtained during this investigation is confidential. The people contacted will be
advised that what they say will be held in confidence.
This field is not part of the form submission.
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