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List ALL work experience beginning with your present or most recent job and working back. Include ALL work experience - full or part time, paid or unpaid, military service, summer jobs, volunteer work, etc. If you have held more than one position title with the same employer, list each position title separately.
Please read carefully.
(Authority for collection of information including Social Security Number (SSN) is contained in 5 USC 3331, 32 USC 708, 44 USC 3101, 32 USC 708, and sections 133, 265, 275, 504, 508, 510, 672(d), 678, 837, 1007, 1071 through 1087, 1168, 1169, 1475 through 1480, 1553, 2107, 3102, 5031, 8012, 8033, 8496, and 9411 of 10 USC and in executive orders 9397, 10450 and 11652.
This authority for collection of information must be signed by you giving the police department of the City of Morgantown permission to do a thorough background investigation with agencies such as the: CREDIT BUREAU, and other agencies which might be of concern for the completion of such investigation. This voluntary release form allows the police department to contact agencies for release of information and accurate documentation concerning your past status.
Principal purpose(s) for which information is intended to be used:
To obtain background information for personnel investigation and evaluate purposed in connection with the making of security determinations with respect to: (1) Employment with the City of Morgantown, particularly in sensitive civilian positions that have been designated as requiring a determination as to whether employment is or assignment to such positions is clearly consistent with the interests of public welfare, (2) Positions of police officer or firefighter or other sworn position, or (3) A position which as access to classified or protected information.
The information will be used to determine your acceptability for employment with the City of Morgantown. The information will be principally used to determine your mental, medical and moral qualifications for employment with the City of Morgantown. If you are accepted and subsequently hired by a component of the City of Morgantown, this information will then become a part of your personnel record.
Your social security number (SSN) is necessary to identify you and your records and to properly report your earnings as an employee of the City of Morgantown to the Social Security Administration, should you be hired. The data is for Official Use Only and will be maintained in strict confidence in accordance with Federal Law and Regulations.
Disclosure of this information and signing of this form is voluntary. However, failure to furnish information or the falsification of any information contained in this application for employment can and will result in the dismissal of the application.
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