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I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check (and consumer report as necessary) as a condition of employment and that continued employment may be based on the successful completion of similar tests.

I hereby release and discharge the City of Madison Heights, the Oakland County Sheriff's Department, and/or the Michigan State Police and their agents from liability for any damage of whatever kind or nature, except for willful or intentional acts, that may result from release of this information to the City of Madison Heights.

I agree that any lawsuit against the City arising out of my employment or termination of employment, including but not limited to, claims arising under the State or Federal Civil Rights statutes, must be filed within six months of the event giving rise to the claims or be forever barred. I waive any limitations period to the contrary.

I waive written notice from my current employer and from any of my former employers regarding the disclosure of disciplinary reports, letters of reprimand, or other notices of disciplinary action contained in my personnel records (even if more than four years old). This waiver is made pursuant to the Bullard-Plawecki Employee Right to Know Act

Unless otherwise indicated above, I authorize the references and current and former employers listed in this application to give you any and all information concerning my current and previous employment and any pertinent information they may have (even if more than four years old) and release all parties from any liability for any damages that may result from furnishing same to you.

I authorize the City of Madison Heights to release any information (even if more than four years old) relating in any way to my employment including disciplinary reports, letters of reprimand or other notices of disciplinary action when such information is requested by prospective or subsequent employers without any obligation (by them or you) to give me any notice of such disclosure.

I have read the job description provided for this position. If employed I understand that if I am or become handicapped in need of accommodations for employment, I must notify the City of Madison Heights HR Department in writing within 182 days after the need is known or reasonably should have been known to me. The requirement is applicable under the Michigan Handicappers Act and this does not preclude any rights an applicant may have pursuant to the Americans with Disabilities Act of 1990, as amended. Failure to properly notify he City will preclude any claim that the employer failed to accommodate.

FOR UNION POSITIONS: In consideration of my employment, I agree to the rules and regulations of the City of Madison Heights. I further acknowledge that if this is a Union position, I will be on probationary status for a period determined by the Union Contract and/or City HR rules and regulations. As a probationary employee, I understand my employment and compensation can be terminated at any time with or without cause and with or without notice at the option of either the City or myself. I understand that no officer or representative of the City has the authority to enter into an agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, except the City Manager of the City and his designee and any such agreement must be made in a signed writing directed to me personally. I further understand that after my probationary period ends, I will be subject to the terms and conditions of the collective bargaining agreement between the City of Madison Heights and pertinent Union. I acknowledge that no one has made any representations or statements contrary to the City's probationary at-will policy to me or about the City's economic outlook or stability either orally or in writing, and I acknowledge that no one has the authority to make such representations or statements to the contrary in the future.

FOR NON UNION POSITIONS: In consideration of my employment, I agree to conform to the rules and regulations of the City of Madison Heights, as they may be amended or changed from time to time, and I agree that my employment and compensation can be terminated with or without cause and with or without notice at any time at the option of either the City or myself. I understand that no officer or representative of the City has the authority to enter into an agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, except the City Manager of the City or his designee and any such agreement must be made in writing, directed to me personally. I further acknowledge that no one has made any representations or statements to the contrary to the City's employment at-will policy or about the City's economic outlook or stability to me, either oral/or in writing, and I acknowledge and understand that no one has the authority to make such representations or statements to the contrary in the future.

I agree that any lawsuit against the City arising out of my employment or termination of employment, including but not limited to, claims arising under the State or Federal Civil Rights statutes must be filed within six months of the event giving rise to the claims or be forever barred. I waive any limitations to the contrary.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.