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2. I hereby authorize the City of Charlevoix Police Department to conduct a background investigation pertaining to my application for employment. I fully acknowledge that this investigation may result in sensitive information being released and may affect my application process. I release from all liability the City of Charlevoix, its officials and employees, and any employer, educational institution, credit reporting agency / bureau and other providers of information about me in any and all respects relating to or a rising from the City’s investigation.
   
   Unless revoked earlier by me, this release shall continue to be effective during my request for employment with the City, during any employment which I may have with the City and, in the case of seasonal employment, for any subsequent consideration of rehiring me. I understand that I may revoke this waiver and authorization at any time.
   
   This release is executed with the full knowledge and understanding that the information is for the official use of the City of Charlevoix and will in no way be circulated in hard copy form or verbally. All hard copy materials will be destroyed via paper shredder.
4. Job Posting Title
6. First Name
7. Middle Name
8. Last Name
10. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
12. Electronic Signature
13. Date
    Date
Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field