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List present employer first. 

This section must be completed in full.  PLEASE DO NOT RESPOND “SEE RESUME”. 

The information provided in this application for employment is true and complete to the best of my knowledge.  In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I authorize investigation of all statements contained in this application and the release of any pertinent information regarding my education, past employment history and background.  I authorize the Town of Bedford to obtain any information from schools, employers or individuals relating to my activities. This information may include, but is not limited to: academics, achievement, performance, attendance, personal history and discipline.  Further, I hereby authorize all references, persons, schools, my current employer (if applicable) and previous employers and organizations named in this application, unless otherwise stated, to provide the Town of Bedford any relevant information that may be required to arrive at an employment decision.  I understand that the information released is for the Town of Bedford’s use only.

I hereby voluntarily release, discharge and exonerate the Town of Bedford, its agents and representatives, and any person so furnishing information from any and all liabilities of every nature and kind arising out of the furnishing or inspection of such documents, records and other information or the investigations made by or on behalf of the Town of Bedford.

I understand that all appointments are probationary and that I must demonstrate my ability for continued employment.  I also understand that I must be available from time to time to work outside normal business hours, as the needs of the department require.  In the event of my employment with the Town of Bedford, I will comply with all rules, regulations, and policies set forth in the Town of Bedford’s Salary Administration Plan Bylaw or other communications distributed by the Town of Bedford.

If required for the position I am seeking, I agree to take a physical examination, which may include testing for drugs or a psychological examination, as required, and recognize that any offer of employment may be contingent upon the results of such an examination.

I understand that any employment offer by the Town is conditional upon my ability to establish employment eligibility under the Immigration Reform and Control Act of 1986 within three days of the date of hire.

Discrimination against any person in any practice or procedure in advertising, recruitment, referrals, testing, hiring, transfer, promotion or any other term, condition or privilege of employment which limits or adversely affects employment opportunities, because of political or religious opinions or affiliations, or because of age, race, color, sex, sexual orientation, national origin, marital status, pregnancy, parenthood, disability, genetics, military status, or handicap which is unrelated to the person’s occupational qualifications or any other non-merit factor which is not a bona fide occupational qualification is prohibited.

It is unlawful in Massachusetts to require a lie detector test as a condition of employment or continued employment.  An employer who violates that law shall be subject to criminal penalties and civil liabilities.

I represent that I have read and fully understand the foregoing and seek employment under these conditions.

I, a candidate for a position hereby authorize the Town of Bedford to investigate all statements in my application and to secure any necessary information from all my employers, references, academic institutions, and credit bureaus.  I hereby release all of those employers, references, academic institutions, credit bureaus, and the Town of Bedford from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the Town of Bedford.

I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my academic credentials and employment references.  I further understand that any false or misleading statements will be sufficient cause for rejection of my application if the Town of Bedford has not yet employed me and for immediate dismissal if the Town of Bedford has employed me.  I also authorize the Town to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having legal and proper interest, and I hereby release the Town of Bedford from any and all liability for its providing this information.

I understand that nothing in this employment application, in the Town of Bedford’s policy statements or personnel guidelines, or in my communications with any Town of Bedford official is intended to create an employment contract between the Town of Bedford and me.  No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Town of Bedford unless it is made in writing and signed by a Town of Bedford official.

I hereby acknowledge that I have read and understand the preceding statement.