Application for Employment

CRIMINAL HISTORY

Have you ever been arrested or convicted of a misdemeanor, arrested or convicted of a felony, admitted guilt to a misdemeanor or felony, pleaded to avoid a misdemeanor or felony, pleaded guilty to a misdemeanor or felony or participated in a pretrial diversion?

I understand and accept that, if I am hired, I may be hired conditional upon passing any medical, and/or psychological examinations that the employer or the Pension Board deems necessary to determine my ability to perform the essential functions of the position. This also includes having successfully completed and passed the CPAT (Candidate Physical Ability Test) within 12 months of the date of hire. I understand and accept that this may include alcohol or substance abuse testing.

I understand that it may be necessary for me to approve and sign waivers necessary in order for the employer to obtain information from my current and former employers.

I understand that the employer provides a seven-day per week and twenty-four hour per day service, and therefore, if employed, I will be required to work twenty-four (24) hour shifts, including weekends and Holidays.

I UNDERSTAND ALL APPLICATION FIELDS MUST BE COMPLETED.

I understand and accept that if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from further consideration. I further understand and accept that, if the employer employs me, I may be subject to disciplinary action, including termination, if any information required by this application has been falsified or intentionally excluded.

I understand and accept that, if I am hired, the initial appointment will be conditional as a Probationary Firefighter. I understand that I must satisfactorily complete a minimum twelve (12) month probationary period to be eligible for appointment as a full-time Firefighter. I further understand that failure to successfully complete the probationary period will result in termination.

I solemnly swear that all of the information furnished in this employment application is true, accurate and complete to the best of my knowledge. I authorize investigation of all statements contained in this application.

I understand that my misrepresentations or falsification of the information provided may lead to withdrawal of an employment offer or termination following employment.

By the submission of this document, I hereby agree that I shall execute the employer's conditional and post-employment medical examination and drug testing consent requirements. I recognize that my future employment with the employer will be jeopardized if I engage in substance abuse, illegal drug use or alcohol abuse.

WHEN YOU REVIEW YOUR INFORMATION ON THE FINAL PAGE, IT IS RECOMMENDED THAT YOU PRINT OR SAVE IT FOR YOUR RECORDS.

The information I have provided herein is correct and complete to the best of my knowledge. I understand that if I misrepresent or deliberately leave out a fact in my application, I may be refused employment or, if employed, I may be terminated. I authorize the City of Evansville to contact previous employers, except where otherwise noted, for reference and verification of statements made. The City has my authorization to investigate my medical and personal history for job-related purposes. I will not hold any official City representative liable for giving or receiving information in this investigation.

I understand that if I am employed by the City that I may terminate my employment at any time and that the City may terminate my employment without notice or cause. I agree to abide by the rules and regulations of the City and I understand that no department head or City official, other than the Mayor, has any authority to enter into any agreement, verbal or written, concerning length of employment, wages, benefits or other conditions of employment. If terminated, the City is liable only for wages or salary earned as of the date of my termination.

I understand and agree that I may be required to take a physical examination as a condition of my employment for the purpose of determining my abilities to perform job duties now or in the future. I agree to consent to take such tests at such time as determined by the City of Evansville and to release the City and its official representatives from any claims arising in connection with the use of information resulting from such examination.

The City is an Equal Opportunity Employer. No question on this application is used for the purpose of discriminating, limiting or excluding any applicant from consideration for employment on a basis prohibited by Local, State or Federal law.

I understand that a criminal history does not automatically disqualify any applicant from participating in the application process or from employment with the City of Evansville. I also understand that, if selected for a job interview, I am required to discuss with the interviewer and disclose on the Criminal History Questionnaire any and all criminal convictions.

WAIVER, RELEASE AGREEMENT AND INFORMED CONSENT

The undersigned, being at least eighteen (18) years of age, and in consideration for allowing the undersigned to continue with the application process to become an employee of the City of Evansville (the "City") within its Fire Department (the "EFD, which includes completing physical tests (the "PROGRAM"), does hereby agree to this waiver and release agreement (the "Agreement") and provides informed consent for medical care.

I recognize that the PROGRAM may involve physical activity and may carry a risk of personal injury and may cause me physical or emotional discomfort. I further recognize that there are natural and manmade hazards, environmental conditions, diseases and other risks, which in combination with my actions in the PROGRAM can cause injury to me. I hereby agree to assume all risks which may be associated with or which may result from my participation in the PROGRAM. I state that I am free from any known health conditions that could prevent me from participating in any of the activities associated with the PROGRAM. I further state that I am sufficiently physically fit to participate in the activities of this PROGRAM.

I certify that, at all times, I shall have medical insurance to cover the cost of any medical care, emergency or otherwise, that I may receive for any illness or injury created by my participation in the PROGRAM. In the event I fail to have medical insurance, I certify that I will be personally responsible for the cost of any medical care, emergency or otherwise, that I receive.

I further agree to release, indemnify and hold harmless the City and the EFD, their agencies, departments, officers, employees, agents, insurers, representatives, elected officials, affiliates, directors, servants, volunteers, members, sponsors and/or officials and staff from any such entity or person, their representatives, agents, affiliates, directors, servants, volunteers and employees from the costs of any medical care that I receive while participating in the PROGRAM or as a result of it.

I further agree to release, indemnify, and hold harmless the City and the EFD, their agencies, departments, officers, employees, agents, insurers, representatives, elected officials, affiliates, directors, servants, volunteers, members, sponsors and/or officials and staff of any such entity or person, their representatives, agents, affiliates, directors, servants, volunteers and employees from any and all liability, claims, demands, actions and causes of actions whatsoever for any loss, claim, damage, injury, illness, attorneys' fees or harm of any kind or nature to me arising out of any and all activities associated with my participation in the PROGRAM.

I further agree to release, indemnify, defend and hold harmless the above-mentioned entities and representative officials from all liability, negligence or breach of warranty associated with injuries or damages from any claim by me, my family, estate, heirs or assigns from or in any way connected with my activities in the PROGRAM.

I further agree to indemnify, defend and hold harmless, and do hereby release the above-mentioned entities and representative persons, from all liability, negligence or breach of warranty associated with injuries or damages caused by my participation in the PROGRAM to any third party(ies).

I further agree that I will not make any audio or visual recording during my participation in the PROGRAM without first receiving permission to do so from a representative of the EFD.

WAIVER, RELEASE AGREEMENT AND INFORMED CONSENT

I have carefully read and understand the contents of the agreement. I do hereby certify, state, and acknowledge that I am not under the influence of alcohol or any mind-altering substance whatsoever. I am free of any duress or coercion. I voluntarily, knowingly, and willingly execute the agreement intending it to cover my participation in the Program.

APPLICANT WRITTEN EXAM SESSIONS WILL BE ON June 24, 2023, AT

SOUTHERN INDIANA CAREER & TECH CENTER
1901 LYNCH RD.
EVANSVILLE, INDIANA 47711

PLEASE CHOOSE A TIME BELOW. (CHECK-IN BEGINS 30 MINUTES PRIOR TO START TIMES.)
NOTE: The morning session is currently FULL. If the afternoon session fills up, we will make accommodations to accept more applicants in both sessions.