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Election Worker Interest Form
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Unit # (if applicable)
How did you hear about becoming an election worker?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)
Do you now or will you require sponsorship for an employment visa (i.e. H-1B)?
If yes, are you able to provide documents as required by law to verify your eligibility to work in the U.S.?
Are you 18 years old or older?
If no, can you produce an employment certification/working papers?
Please read the below statements and certify your acknowledgment below.
I certify that all information provided in this application is true and complete to the best of my knowledge and belief. In the event of an offer of employment, I understand that false, misleading or omitted information in my application shall be grounds for withdrawal of an offer of employment or discharge at any time. I certify that I am under no agreement with any prior employer or another third party which would prevent me from accepting employment with the Town of Amherst which would otherwise adversely affect or restrict such employment. I understand that the use, purchase, transfer, possession, sale or being under the influence of alcohol, illegal drugs, or controlled substances while on the Town of Amherst’s premises, the premises of any Town of Amherst worksite, or while engaged in the Town of Amherst business is strictly prohibited and is grounds for immediate discharge. I am willing to submit to a drug and/or alcohol test to detect the use of illegal drugs or alcohol prior to or during employment, as to the extent of permitted by law. I agree to submit to medical examinations, as may be legally permitted and required by the Town of Amherst to the extent necessary to determine my ability to safely perform all essential job functions. I understand that pursuant to the Massachusetts General Laws, smoking is not allowed in Town buildings. Also, Massachusetts General Laws state that no person who smokes any tobacco product shall be eligible for appointment as a police officer or firefighter. Should my employment terminate, I understand the Town of Amherst may be asked by prospective employers to provide an employment reference on my behalf. I hereby release the Town of Amherst from any liability and claims in connection with the provision of employment references. It is my understanding that the Town of Amherst may make a thorough investigation of my entire work and personal history and may verify all information given in my application for employment, related papers or oral interviews. I understand that the Town of Amherst may disclose to a third party some or all of the information given in my application as a part of the background investigation. I authorize such investigation and the giving and receiving of any information request by the Town of Amherst and I relates from liability and claims any person or organization giving or receiving any such information, including but not limited to the Released Parties. I understand and agree that the Town of Amherst may obtain a consumer report from a third party consumer reporting agency, as these terms are defined in the Fair Credit Reporting Act, for the purposes of obtaining such information and completing such investigations. I understand that employment is contingent upon the results of a background investigation, on verification of data provided by me regarding my application, and may also be contingent upon a driving record investigation for positions involving the use of a motor vehicle. I understand that an offer of employment is contingent based on the satisfactory completion of these items. I understand that this is an application for employment and that no employment contract or promise is being offered. I understand that if I am employed by the Town of Amherst such employment is on an at-will basis. I understand that the “at-will” means that both the Town of Amherst and the employee have the right to terminate the relationship at any time, for any reason, with or without notice. The Town of Amherst reserves the right to change wages, benefits, practices, policies and working conditions at any time. I understand that it is unlawful in Massachusetts to require a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Yes, I acknowledge and certify the above statements are true.
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