NPFD/HHPD Authorization Form

APPLICANT RELEASE AND AUTHORIZATION FORM

Village of Harwood Heights
"Authorization to obtain; Criminal Background and General Background for Employment Purposes only"
I hereby authorize The Village of Harwood Heights, or any of its authorized representatives to obtain reports regarding any/all of the following:

Criminal background and Drug Screening.
The background checks shall be conducted by the Harwood Heights Police and may utilize any consumer reporting agency, State agency or any outside service engaged by the Board of Trustees deemed necessary to accomplish that task.
The applicant understands that the completion of this form is required before he/she can be hired.
Applicant Legal Name
Applicant Social Security Number
Applicant Date of Birth (month/date/year)
ApplicantSignature

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I hereby fully release and discharge my prospective employer or other source providing information from all claims and damages out of or relating to any investigation of my background for said purpose.
Applicant Legal Name
Applicant Signature

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Date

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NORWOOD PARK FIRE PROTECTION DISTRICT

AUTHORIZATION FORM
Date

MonthDayYear
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I, First Name Last Name, hereby authorize the NORWOOD PARK FIRE PROTECTION DISTRICT and its agents, employees or representative to obtain and use all information relating to my previous and current employment, education, military record, criminal conviction history, personal characteristics and all other information which may bear favorably or unfavorably upon my application made to the NORWOOD PARK FIRE PROTECTION DISTRICT. I also consent to the release to the NORWOOD PARK FIRE PROTECTION DISTRICT of any and all medical records prepared during the physical examination I am required to undergo for applying to the NORWOOD PARK FIRE PROTECTION DISTRICT. I further release from liability any person or persons providing or receiving any such information in connection with this pre-hiring investigation.

I also agree to indemnify and hold harmless the NORWOOD PARK FIRE PROTECTION DISTRICT, the Board of Fire Commissioners, the individual trustees and commissions, employees and agents against any claim or loss whatsoever, including but not limited to attorneys' fees and any cost of defense which arises directly or indirectly out of any injury which I might sustain in the application process. I also covenant that for the consideration of my application. I agree not to sue the NORWOOD PARK FIRE PROTECTION DISTRICT, the individual trustees and commissioners, employees and agents for any injury, loss or damage as a result of such process including but not limited to personal injury, wrongful death, court cost, attorneys' fees and interest, in any manner caused directly or indirectly, including negligent acts or omissions of the NORWOOD PARK FIRE PROTECTION DISTRICT, trustees and commissioners as well as its employees and agents.

I hereby acknowledge and agree that as a condition of continued employment with the NORWOOD PARK FIRE PROTECTION DISTRICT, I must maintain at all times a valid State of Illinois driver's license, of the Class required to operate all vehicles of the NORWOOD PARK FIRE PROTECTION DISTRICT. I do further agree that my failure to maintain said driver's license will constitute reason for withdrawal of a conditional offer of employment or just cause for dismissal of employment with the District.

Signature

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. This organization is committed to the policy of equal employment opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job-related experience and other qualifications will be considered without discrimination on the grounds of race, color, religion, sex, national origin, age, or physical or mental handicap. All information provided in this application will be treated confidentially and will be used only to help assure the best use of your abilities if you are employed with us.
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APPLICANT RELEASE AND AUTHORIZATION FORM

"Authorization to obtain; Criminal Background and General Background for Employment Purposes only"

I hereby authorize The Village of Harwood Heights, or any of its authorized representatives to obtain reports regarding any/all of the following:

The background checks shall be conducted by the Harwood Heights Police and may utilize any consumer reporting agency, State agency or any outside service engaged by the Board of Trustees deemed necessary to accomplish that task.

The applicant understands that the completion of this form is required before he/she can be hired.

I hereby fully release and discharge my prospective employer or other source providing information from all claims and damages out of or relating to any investigation of my background for said purpose.

NORWOOD PARK FIRE PROTECTION DISTRICT