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I hereby declare and certify that the answers or statements I have supplied on this Application are true, complete and correct to the best of my knowledge. I understand that any and all information provided as part of this application is subject to verification. I understand that any false or misleading information provided, or any omission or concealment of facts, will disqualify me from consideration for employment, and constitute grounds for my immediate dismissal should I be employed by the City. I understand that I will be asked to furnish proof of eligibility to work in the United States upon being hired. My signature authorizes City of Redwood Falls to secure my driving record (if position requires a valid driver's license and/or proof of equivalent mobility), transcripts from educational institutions to verify credits/degrees and information needed to obtain criminal background check. It also authorizes collection of any employment related information deemed necessary from current or former employers, organizations where I have volunteered ("volunteer organizations") named in this application or personal references. I agree to hold harmless those individuals, organizations, and City of Redwood Falls for any information provided or received. I understand the City will use this information to determine my fitness qualifications for the position I am seeking. This authorization expires one year from the date of my signature below.

I hereby release the City and all current and former employers, volunteer organizations and references listed herein and any and all agents acting on behalf of said City, former employers, volunteer organizations or references, from any and all liability of whatever nature by reason of requesting or providing such information.

YOUR RIGHTS AS A SUBJECT OF DATA

Minnesota Statutes Chapter 13 requires that you be informed that the following information which you are asked to provide in the employment application process is considered private data: Name, Home Address, Home Phone Number, information regarding disability or any reasonable accommodation, and Racial/ Ethnic Data.

This means the data is available only to you and City officials who have a reasonable and work-related need for it during the hiring process. This data may also be available to other agencies with statutory authority, including law enforcement agencies and persons or entities authorized by law or court order.

The data will be used to identify you within the hiring process. Refusal to supply Name, Home Address and Home Phone Number may result in your application not being considered. Furnishing racial/ethnic data, age and gender is voluntary and will not be used by City of Redwood Falls as a criterion for employment.

Information regarding disability or any reasonable accommodation will be used to provide reasonable accommodations during the hiring process. Refusal to provide information regarding disability or any reasonable accommodations may result in City of Redwood Falls not being able to accommodate you during the hiring process. Information regarding disability or any reasonable accommodations will be maintained separately and will be treated as private medical records. Your name will become public data when you are certified as eligible to be selected to fill a vacancy. All other information you supply on this application, with the exception of that which is private data as indicated above, will become public if you are hired by City of Redwood Falls.

EQUAL OPPORTUNITY EMPLOYER

City of Redwood Falls, an Equal Opportunity Employer, is committed to provide for all, without discrimination, equal employment opportunity to hire and promote without regard to such non-job-related distinctions on the basis of race, color, creed, religion, national origin, disability, marital status, sexual orientation, sex (except when sex is a Bona Fide Occupational Qualification) or status with regard to public assistance.

PUBLIC SAFETY APPLICANTS ONLY:

In consideration of being permitted to apply for the position herein, I voluntarily assume all risks in connection with my participation in any tests the City of Redwood Falls deems necessary to determine my fitness and eligibility, and I release and forever discharge the City of Redwood Falls, its officers and employees from any and all claims for any damage or injury that I might sustain.

I hereby declare that I have read all the statements above. I acknowledge and understand what information I supply is done so with regard to the Minnesota Government Data Practices Act. (Minnesota Statutes 13.01 - 13.88)

Candidates for positions working with children will not be selected if they have been convicted of any crime listed in the Child Protection Worker Act (Minnesota Statutes 299C.61 & 62). Generally, this includes child abuse crimes, murder, manslaughter, felony level assault or any assault crime committed against a minor, kidnapping, arson, criminal sexual conduct, and prostitution-related crimes.

Before any applicant (other than applicants for positions within the police or fire department) is rejected on the basis of criminal conviction, he or she will be notified in writing and will be given any rights afforded by Minnesota Statutes Chapter 364. This includes the right to show evidence of rehabilitation.

Application Instructions - Points are awarded subject to the Minnesota Statutes 43A.11. You must supply a copy of DD214 by the application deadline. If the DD214 is not received Veteran Preference Points will not be awarded.

Disabled veterans must also supply an equivalent letter from a service retirement board. Spouses applying for preference points must supply their marriage certificate, the veteran's DD214 or death certificate.