HomeMy WebLinkAboutBackground Check memo from 6-22-09 COMMISSION MEMORANDUM
REPORT TO: Honorable Mayor and Commission Members
FROM: Chris Kukulski, City Manager
SUBJECT: Background Checks and City Review of Password Protected Internet
Information
MEETING DATE: June 22, 2009
RECOMMENDATION: Listen to staff presentation on: (i) historic use of usernames and
passwords for access to a candidate's password protected internet
site; (ii) City Manager's decision to stop this practice for all positions;
and (iii)the City Manager's decision to evaluate with the cooperation
of the City Commission the possible use of password protected
internet sites for law enforcement.
This item has been noticed as a discussion on the use of the internet for City background
checks. The City Manager's presentation includes a request that the Commission participate
in future discussions regarding these issues where definitive action by the Commission can
be taken.
BACKGROUND: The practice of the City of Bozeman requesting the usernames and passwords
for password protected internet sites from applicants receiving conditional offers of
employment has been brought to the attention of the City Commission. Individual
Commissioners have requested I provide an explanation of the City's practices as well as
provide an overall description of the City's recruitment and selection processes for
Commission review. Attached is an overview of the City's background investigation elements
and facts related to the collection of usernames and passwords for City job candidates.
Below are the facts related to the City's request for usernames and passwords for protected
internet sites:
• As of Friday June 19, 2009, the City suspended asking for any usernames and
passwords for password protected internet sites. This included discontinuing the
use of usernames and passwords to access password protected internet sites of
potential employees for whom we already have obtained the information.
• The standard practice was that username and passwords were to be used to access
personal sites only after a conditional job offer was made.
1
• No candidate was ever disqualified or penalized for not disclosing usernames and
passwords to these password protected sites.
• The only staff to review any password protected information was the Human
Resources Department for employees other than police and fire, Detective's
Division of the Police Department for police and fire candidates, and the Fire Chief
and Deputy Fire Chiefs for fire candidates.
• Hiring committees do not participate in background investigations. The
background investigations are conducted by the Human Resource, Police and Fire
Departments.
• Protected class information was never used in consideration of candidates.
Public Safety: For police officers,the City is required by law to conduct a thorough
background investigation (MCA 7-32-303). The process of requesting access to police and fire
candidate's social networking sites was established because their duties and responsibilities,
(powers of arrest, unsupervised entry into dwellings and business, providing medical care )
required a more thorough background screening to be performed before conditional job offers
became final. At that time, candidates considered for public safety, after receiving a
conditional offer of employment, were required to undergo numerous evaluations including
psychological, medical, hearing and vision evaluations, objective pre-employment interviews
and more rigorous background investigations than applicants outside of police and fire
positions typically would have been subject to. Investigations that can rule out personal
associations with known criminals or can detect other criminal activity that is not reported in
national criminal record databases are a critical element to our determination of suitability for
law enforcement positions.
Extent of Background Checks for Various Personnel: As a condition of employment,the City
of Bozeman conducts comprehensive background checks on all candidates with conditional
job offers. Prior to Friday's decision by the City Manager, the City evaluated a candidate's
password protected internet sites. This practice is no longer being employed. Thus, as of
today,the following identifies the City's current practice of conducting background checks:
City Administration (CM, ACM and Department Directors) :
• Screen Now criminal background and financial credit checks. (Subject to federal
Fair Credit Reporting Act--see below.)
• Driving record check (Montana database or use Screen Now for out of state drivers
licenses.)
• Review of publicly accessible internet information.
• Extensive reference checks.
Public Safety (Police officers, Firefighters)
• Firefighters - Screen Now criminal background check (checks for convictions)
• Police Officer- NCIC criminal history and local records check.
• Credit check/financial investigation.
2
• Driving record (Montana database or use Screen Now for out of state drivers
licenses).
• Review of publicly accessible internet information.
• Extensive reference checks.
• Objective pre-employment interview.
• Psychological, medical, hearing and vision evaluations as appropriate to the
position.
• Personal history questionnaire.
Other positions with law enforcement-related responsibilities (City Attorney,
Information Technology)
• NCIC criminal history check for those positions with NCIC access; or
• Screen Now criminal background and credit checks.
• Drivers license checks, if required for the position.
• Review of publicly accessible internet information.
• Extensive reference checks.
Positions dealing with confidential information and those having access to public funds
(HR, finance, etc.)
• Screen Now criminal background check.
• Credit check.
• Drivers license checks, if required for the position.
• Review of publicly accessible internet information.
• Extensive reference checks.
Employees who are required to have a commercial drivers license:
• Screen Now criminal background check.
• Driving record.
• Pre-employment drug test, prior DOT drug testing results.
• Review of publicly accessible internet information.
• Pre-employment medical exam (as appropriate to position).
• Extensive reference background.
All other hires not specifically listed above:
• Screen Now criminal background check.
• Driving records check if applicable to the position.
• Pre-employment medical exam (as appropriate to position).
• Extensive reference background.
• Review of publicly accessible internet information.
All positions: We have been checking sexual and violent offender registries and
probation/parole sites of locations where the applicant has resided.
3
Fair Credit Reporting Act. The federal Fair Credit Reporting Act (FCRA) applies whenever an
employer uses the services of a consumer reporting agency (Screen Now is a CRA). The FCRA
requires that, before any adverse impact is taken as a result of information received through a
CRA, the applicant must be informed of the information, and given time to correct any
erroneous records. Even though the City's use of the State's information (violent offender
registry, drivers' license database) is not through a CRA, it is HR's policy to follow the adverse
impact review procedure whenever information surfaces which may result in an adverse
impact on the applicant.
GOING FORWARD: We will no longer be looking at password-protected internet information
for job candidates. With the assistance of our recently hired City Attorney, we recommend
scheduling a Policy Meeting (within 30 days) for an update on city hiring procedures. This will
include a discussion regarding the appropriate level of screening for public safety pre-
employment background checks.
This was an honest mistake. Human Resources, our Police and Fire Departments were doing
something they believed was consistent with our core values. I take full responsibility for this
decision and we will work hard to regain the trust and confidence of the City Commission and
our community.
ALTERNATIVES: As suggested by the City Commission.
ENCLOSURES:
• Recruitment and Selection Procedures
• Position Vacancy Checklist
• Employment Process Policy
• Consent and Release to Conduct Criminal Background and Reference Checks form
4
RECRUITMENT AND SELECTION PROCEDURES
Updated October 28, 2005
�. Selection and Hiring Authority
1 . The City Commission reserves the exclusive right to hire,
discipline and fire the City Iianager.
2. The City Commission invests in the City Manager the authority
and responsibility of carrying out the policies, procedures,
and intent of the Personnel Policies and Procedures Manual.
This authority includes the power to hire, discipline and fire
all personnel.
B. Purpose
The purpose of these procedures is to ensure equal treatment of all
applicants regardless of race, color., religion, czeed, sex, age,
marital status, national origin or disability.
C. Applicability
These procedures shall be applicable to all positions which become
vacant within the City Bozeman, including but not limited to-
newly-created positions, internships, part-time, full-time,
temporary, seasonal, specially-scheduled positions, etc. The
Personnel Director- will be informed of all position vacancies and
will be responsible for overseeing their recruitment and selection
procedures.
0. Recruitment and Selection Procedures
1. Job Description Review - As soon as knowledge of a vacancy occurs,
a Position Vacancy Announcement will be prepared by the
Personnel Director. This Announcement will be reflect the
duties contained in the Job description and should include the
primary objective of the position, major areas of
ac:countabiIity and performance, working conditions and
physical requirements, minimum and desirable qualifications,
rate of pay and date position is to be filled. In addition,
the Supervisor may include any special qualifications sought
in filling the position.
2 Selection Plan - In filling positions, the City of Bozeman may
use any combination of selection procedures which meets its
needs including but not limited to resume s, applications,
application supplements, screening tools, structured oral
interviews, written exercises, case studies, physical agility
tests, reference cheeks, etc. A Selection Plan will be in
1
Social Networks Page 4
needs incladirig but not limited to resume s, applications,
application supplements, screening tools, structured oral
place prior to initial recruitment which shall include, at a
minimum, the following components:
a) Applicant Screening Form - This form will list this job-
related required and desired qualifications for the
vacant position and will be used to screen out those
applicants who fail to meet rinimum position
qualifications, as well as to identify those candidates
who are best qualified for further consideration.
bl Interview 'Tool - An Interview will be prepared which
lists questions to be asked of all applicants who qualify
for an interview. The questions to be asked shall be job-
related and, whenever possible, the results of the
interview shall be scored using a predetermined numerical
rating with point values assigned for preferred
responses.
c) Reference Inquiry Form - As with the screening and
interview tools, a reference inquiry form shall be
prepared in advance and shall relate to the app;icant's
ability to perform the specific duties of the vacant
position.
The Selection Plan shall be developed by persons knowledgeable
of the position and shall be reviewed and approved by the
Personnel Director. In cases when the Selection Plan includes
components outside of those listed above, these components
must also be in place prior to initial recruitment .
A Hiring Committee shall be recommended by the Department Head
or his/her designee, and approved by the Personnel Director.
This Committee will be responsible for preparing the Selection
Plan and for participating in the selection process.
Committee members may include the Department Head, the
position's supervisor, a person who has similar duties, the
Personnel Director, etc.
3. Recruitment Procedures
It is the City of Bozeman', policy to insure that its
recruitment procedures afford adequate opportunity for the
promotion and transfer of permanent part-time and full-time
employees. Therefore, whenever circumstances permit., internal
recruitment will be completed prior- to external recruitment
for position openings. If at the close of the internal
recruitment period, no applicant is selected, external
recruitment will begin. However., when circumstances dictate
the need, internal and external recruitment will be conducted
simultaneously. Recruitment procedures are as follows:
2
Social Networks Page 5
a. Internal Recruitment - Notice of vacancies will be
advertised internally by posting on the bulletin boards
of all City offices for a minimum of five (5) r,orking
days. During this internal recruitment period, City of
Bozeman employees who meet the minimum qualifications
will be encouraged to apply, and will be given specific
instructions on where=, when and how to apply.
b. External Recruitment - The Personnel Director will be
responsible for coordinating external recruitment
procedures. Positions will be advertised in appropriate
statewide media, Job Service, and Affirmative Action
recruitment sources, for a minimum of five (5) working
days.
C. Special Circumstances Under certain circumstances, the City
reserves the right to dispense with the formal selection
procedures. These special circumstances include, but
are not limited to, Positions reopening within six
months, when only one internal applicant applies, special
employment programs and emergencies. Other special
circumstances will be considered, by the Personnel
Director, on a case-by-case basis.
1) Positions Reopening within Six Months If, after
being occupied for a period of six (6) months or
less a position becomes vacant, the City will
implement appropriate internal recruitment
procedures. If no successful applicant is found
internally, the Department Head/ Supervisor may,
with the consultation of the Personnel Director,
select one or more of the following options to fill
that position:
a. The Department Head/Supervisor may offer the
position to any applicant identified, during
the initial hiring process, as meeting the job
requirements. Reference checks must be
completed, in advance of any employment offer,
on the applicant being considered for the
position. This process may be used until all
qualified interviewees have been otfered the
position.
b. Interview additional qualified individuals
with applications on file;
C. Implement the external recruitment process.
The six month period begins ends six months after
the starting employment date initial candidate.
3
Social Networks Page 6
2) Like Positions - If within a six (6) month tirc.rr
period of recruitment, a position requiring similar
qualifications and involving similar duties becomes
vacant, the City of Bozeman will immediately
implement the internal recruitment procedures
described in paragraph D.3.a. If no successful
applicant is found internally, the Personnel
Director and the position's Supervisor may employ
one or both of the following options to fill that
position:
a. Interview qualified individuals with
applications on file;
b. Implement the external recruitment process in
accordance with D,3.b above.
3) Known Abilities - When, during internal
recruitment, only one employee applies, the
Personnel Director shall perform initial applicant
screening. If the applicant is found to meet the
minimum qualifications, and the Hiring Committee
determines that the employee's skills and abilities
satisfy those demanded by the job, the remaining
selection procedure may be dispensed with upon
concurrence of the Personnel Director.
4) Temporary Positions - Temporary positions within
the City of Bozeman shall not require advertising.
The appropriate supervisory personnel shall inform
the Personnel Director of position availability.
The Personnel Director will then use appropriate
referral sources to recruit for these positions.
If it becomes necessary to convert these temporary
positions into permanent ones, the requirements of
paragraph D. 3.a shall be immediately implemented.
5) Seasonal Positions - Seasonal positions within the
City of Bozeman shall not require advertising. The
appropriate supervisory personnel shall inform the
Personnel Director of position availability. The
Personnel Director will then use appropriate
referral sources to recruit for these positions.
If it becomes necessary to convert these seasonal
positions into permanent ones, the requirements of
paragraph D. 3.a shall be immediately implemented.
6) Internshjps - Internship positions within the City
of Bozeman shall riot require advertising. The
appropriate supervisory personnel shall inform the
a
Social Networks Page 7
1', rconnel Director of position availability. The
Personnel Director will then use appropriate
_ ( lerrals sources to recruit for these positions.
if it becomes necessary to convert internships into
permanent positions, the requirements of paragraph
D.3.a shall be immediately implemented.
7) Vacancies in the Position of City MarracL -
Procedures to fill the vacancies in the position of
City Manager will be established by the City
Commission.
8) Bng, cial Employment Programs - Special employment
programs are those funded, in whole or in part., by
external agencies and include employment training
programs, volunteer programs, and internships.
Where the need for a special employment program
placement is deemed necessary or beneficial, the
Department Heads/Supervisors fox-ward their requests
to the Personnel Office which, in cooperation with
the requesting department, develops a statement of
tasks to be performed. The request is then
forwarded to the appropriate external agency(ies)
for action.
The Personnel Office will review and maintain
records on special employment program participants,
including any contractual agreements between the
City and the provider agencies. Department
heads/Supervisors are responsible for providing the
Personnel Office with regular performance
evaluations on program participants and feedback on
program strengths and weaknesses.
9) Emergencies - Whenever an emergency exists which
requires the immediate services of one or more
persons and it is not practical or possible to
secure the services of such persons through the
normal recruitment process, the Department
Head/Supervisor may, upon consultation with the
Personnel Director, make emergency appointments for
a period not to exceed sixty (60) calendar days.
Em•2rgency appointment employees shall not be
entitled to City employee fringe benefits, except
as specifically provided under state law and/or in
these policies.
5
Social Networks Page 8
4. Selection Procedures:
a. Arnpl i.cant Screening - The Hiring Conuni ttee shall
review applicant qualifications using the criteria
found in the Applicant Screening Form.
b. lnterview Recommendations - Based on the results of
applicant screening, the Hiring Committee shall
recommend to the Department Head or designee,
persons to be interviewed. The Department Head or
designee shall forward the list to the Personnel
Director for review. When appropriate, the
Personnel Director will expand the list of persons
to be interviewed to include members of affected
classes who meet the minimum qualifications of the
vacant position, and for whom a target hiring goal
has been established. The Department Head or
designee will then provide the Hiring Committee
with the list of persons to be interviewed. Those
applicants selected to be interviewed will he
contacted by the Department Head or his/her
designee.
C. EmpIovment Interview - The employment interview
will he conducted by the Hiring Committee using the
pre-approved Interview Tool.
d. Reference Inquiries - At least two (2) reference
inquiries shall be performed for each job finalist .
The Reference Inquiry form will have been approved
as part of the Selection Plan.
e. Selection Recommendation - The Hiring Committee
;,hall provide the Department Head or designee with
all notes and ratings resulting from the selection
process as well as a list of persons who best meet
the position qualifications. Based on the
information provided, the Department Head or
designee shall select the person to be hired, and
shall forward the materials to the Personnel
Director. The Personnel. Director will review the
hiring process used and will indicate reasons for
agreement or disagreement with the selection
decision.
f. Selection - After Personnel Director review of the
hiring Recommendation, the Department Head or
his/her designee shall formally offer the position
to the selected applicant. A letter of
ackno,aledgment will follow from the Personnel
6
Social Networks Page 9
Director which states the position title, tyre of
appointment, starting salary, beginning date of
employment, dates of probationary period, and the
name anti location of the position's supervisor. A
job acceptance statement will also be included.
g. Notification of Non-Selectees - All non-selected
candidates will he notified, in writing, by the
Personnel Director, that they were not selected and
the reason for non-selection.
E. Document Maintgnance
11he following materials shall be included among the documentation
for each selection:
1 . The position description;
2. A copy of the vacancy ox position announcement.
.3. A copy of the newspaper advertisement, if any, and a list of
all recruitment sources used;
4. All applications, application supplement questionnaires, and
any other application materials received;
5. A copy of the Selection Plan, including all selection
procedures and any criteria used to evaluate performance;
6. Any written evaluations;
7. The names and titles of any persons who participated in the
design or administration of the selection procedures;
8. Records or other information for applicant flow;
9. ('orrespondence with applicants.
The items mentioned above shall be retained by the Personnel
Director for a minimum of three (3) years from the official
selected candidate's date of hire.
Social Networks Page 10
POSITION VACANCY CHECKLIST
In its hiring process,the City follows Uniform Guidelines on Employee Selection Procedures These provide guidance to employers to help them comply
with federal laws which prohibit discrimination in employment based on race,color,religion,sex and national origin.The guidelines apply to employers
who are subject to Title VII of the Civil Rights Act of 1934 or Executive Order 11246
An employment selection process is considered discriminatory if it has an adverse impact on the hinng,promotion or other employment opportunities of
individuals because of race,sex or ethnicity;that is,if the selection rate for any race,sex or ethnic group is less than 80 percent for the group having the
highest selection rate.A selection procedure that results in an adverse impact is allowed to stand if the employer can demonstrate That the test measures
a trait necessary for successful performance of the job.Or,the employer can eliminate the factor from the selection process which has caused the
adverse impact. The Guidelines also require maintenance of detailed records on the employment selection procedures The following checklist ensures
the City's hiring practices comply with these guidelines.
Position: Prepared by.
AS SOON AS KNOWLEDGE OF POSITION VACANCY OCCURS: RESPONSIBLE PARTY: DATE
Review current Class Specification for revisions CURRENT EMPLOYEE AND SUPERVISOR
I Verify FLSA status_ —Exempt ,Non-Exempt `Not covered EMPLOYMENT SPECIALISTJHR DIRECTOR
Obtain Department Head approval to fill SUPERVISOR
ADDITIONAL ACTIONS TO BE TAKEN: RESPONSIBLE PARTY: DATE:
I Identify Application Materials Required(check all that apply) SUPERVISOR
City App f;Resume 7 Cover Letter
Copy of Driver's License 17 Copy of Transcripts J Copy of relevant certification(s)
Application Supplement 'I Keyboarding Test I Other(specify).
I Prepare position vacancy announcement. EMPLOYMENT SPECIALIST
Internal Recruitment. Begins:_ Ends:
External Recruitment:Begins: Ends:
Appoint Hiring Committee SUPERVISOR
- Prepare Selection Plan(at least these 4 items need to be created.updated) HIRING COMMITTEE
Screening Tool Interview Toot Reference Check - Safety Checklist
Other(specify):
Send Selection Plan to Employment Spec,alist for Review SUPERVISOR Before recruitment ends
(including compliance with uniform guidelines)
Preliminary Screening EMPLOYMENT SPECIALIST
Applicant Screening HIRING COMMITTEE
Recommendation for interviews-Return screening tools HIRING COMMITTEE
to Employment Specialist;send memo recommending those
applicants to interview
Review results,apply preference points,final list of interviewees EMPLOYMENT SPECIALIST
to Supervisor --
Letters to non-interviewees EMPLOYMENT SPECIALIST _
Call Interviewees SUPERVISOR OR DESIGNEE
Conduct Interviews HIRING COMMITTEE
Apply appropriate preference points-Call Employment SUPERVISOR
Specialist to determine which,if any applicants,are
eligible for preference points under the law
Reference Checks-Complete at least 3 reference checks SUPERVISOR OR DESIGNEE
on at least top 2 candidates
Recommendation for hire Prepare memo to Department HIR!NG COMMITTEE
Head/Supervisor listing hire recommendation as well as
reasons for recommendation. Include all interview notes and
reference checks with recommendation
Concurrence or Disagreement-forward file to Employment DEPARTMENT HEAD
Specialist for Final Review
-I Notify position's supervisor of approval or rejection of EMPLOYMENT SPECIALIST
hiring recommendation(adverse impact analysis)
Offer candidate the position;Notify Employment Specialist SUPERVISOR
of beginning employment date:
Conditional offer elements are explained in verbal offer and hire letter to include but need not be limited to drug tests,medical exams criminal
background checks,drivers'license status checks,and post hire certification requirements.
Prepare hire letter;notify other candidates of non-selection, EMPLOYMENT SPECIALIST
and File Maintenance —�
Social Networks Page 2
Employment Process Policy (Information for Applicants from City of
Bozeman website )
People interested in employment with the City of Bozeman should be aware of the following:
1. The City does not accept unsolicited applications When vacancies occur,the City uses the
Bozeman Job Service for recruitment and application collection.
2. It is extremely important to follow the instructions found on the Position Vacancy
Announcement,the Application,the Supplement Questions and any other application materials.
Incomplete,late andfor unsigned application material,including those which do not follow the
instructions,will NOT be considered
3. Benefits:Currently,City of Bozeman benefits for full-time employees (subject to change
depending on availability of funds)include:medical,dental and vision insurance,prescription drug
coverage,flexible benefits plan,15 days vacation and 12 days sick leave per year, 11 paid
holidays,retirement,life insurance,health club membership,and an optional deferred
compensation retirement plan.
Currently, part-time employees accrue prorated vacation and sick leave based upon the number of
hours worked,from their beginning date of employment.Part-lime employees will receive prorated
holiday benefits,based upon the average number of hours worked per day.
4. Equal Employment Opportunity: It is the policy of City of Bozeman that the City does not
discriminate on the basis of race,color,religion,creed,sex,age,marital status,national origin,
political ideas,or disability in employment or the provision of services This policy does not preclude
discrimination based upon bona fide occupational qualifications or other recognized exceptions
under the law.
5. The Montana Human Rights Act requires the City of Bozeman to make and keep records relevant
to the determinations of whether unlawful employment practices have been or are being committed
The City of Bozeman Equal Employment Opportunity Applicant Survey(attached to the application)
once completed,will be separated from your Application.The survey information will be kept
confidential,used only for statistical reports and other lawful purposes.The information you and
others provide will be used to monitor the City's recruitment and selection practices.This form is
optional failure to complete this form will have no impact on any employment decision.
6. Application and Selection Process The process used to evaluate an applicant's qualifications
may include,but is not limited to an evaluation of the City of Bozeman Application for Employment
and supplemental questions if required,a performance test or work sample,a structured interview
and reference and background checks.Applicants will be notified when screening has been
completed.
7. Reasonable Accommodations:The City of Bozeman makes able accommodations for any known
disability that may interfere with an applicant's ability to compete in the recruitment and selection
process or an employee's ability to perform the essential duties of the job. For the City to consider
any such accommodation,the applicant must make known any needed accommodation
8. Employment Preference:The Veteran's Public Employment Preference Act and the Persons with
Disabilities Public Employment Preference Act provide preference in public employment for certain
military veterans and people with disabilities or their eligible relatives.Applicants wanting to claim
either veterans or disability preference must provide the appropriate documentation of eligibility with
the application.The required documentation may include a DD-214;a document issued by the
Office of the Adjutant General of the Montana National Guard certifying service;or a PHHS
Certifications of Disability form.Contact your local Montana Vocational Rehabilitation Services
Office,Department of Public Health and Human Services for details on obtaining persons with
disabilities preference certification.For more information,contact the Human Resources office at
(406)582-2300.
9. Immigration Reform and Control Act: In accordance with the Immigration Reform and Control
Act,the person selected must produce within three days of hire,documentation that he or she is
authorized to work in the United States.Examples of such documentation include a birth certificate
or social security card along with a driver's license or other picture I.D.,a United Stales Passport,
Certificate of Naturalization,a Permanent Resident Card,an Alien Registration Receipt Card
(Greed Card)or a Resident Alien Card
http://www.bozeman.netio zgmLnLhiimv-nR r e r F<.pc a�px
Social Networks Page 1
r
Y�• r�-. •�cT
tf383
THE CITY OF BOZEMAN, MONTANA
CONSENT AND RELEASE TO CONDUCT CRIMINAL BACKGROUND and REFERENCE CHECKS
Dated this__ day of 20_
Waiver Statement
hereby authorize the City of Bozeman,Montana and/or its agents to conduct an investigation of
my background,references,character,past employment,education,credit history,criminal or police records,including those maintained by both public and
private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information
which may be material to my qualifications for employment now and,if applicable,during the tenure of my employment with Company.
I release the City of Bozeman,Montana and/or its agents and any person or entity,which provides information pursuant to this authorization,from any and all
liabilities,claims or law suits in regards to the information obtained from any and all of the above referenced sources used.
I hereby expressly authorize release of any and all information which you,as a previous employer or employment reference,may have conceming me,
including information of a confidential or privileged nature. I hereby release any organization,company,institution or person for which I have been
employed furnishing the information requested.
In accordance with Montana Constitution,Article I1,Section 9,I understand I have the right to review information obtained through the reference
check process;however,by signing below,I realize the City of Bozeman will NOT release the information provided to them to any person,including
myself. The information submitted is confidential and will be used only for the purpose of determining my suitability for the position which I applied.
***************Complete Section 1,but do not sign this form until you are present with a Notary***************
Current Address City State _ Zip
I _I -
Date of Birth(mm/dd/yyyy) Social Security Number
Driver's License Number State Expiration Date(mm/dd/yyyy)
Please list any and all,past and present,personal or business website or web pages,memberships on any Internet-based chat rooms,social clubs
or forums,to include but not limited to: Facebook,Google,Yahoo,YouTube.com,MySpace,etc.
'Websit o r U rna a/Me er :o -In a wor i c ble
Maiden and/or Other Names Used:
Print Legal Name(First Middle Last) Signature(Must be witnessed by Notary)
APPLICANT:READ THE WAIVER STATEMENT BEFORE SIGNING,IF NOT UNDERSTOOD,SEEK COMPETENT LEGAL ADVIC E.
Section 2: (to be completed by a Notary)
STATE OF
County of
On this before me,the undersigned,a Notary Public for the State of
personally appeared ,known to me to be the person whose name is
subscribed to the within instrument and acknowledged to me that he/she executed the same.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed my Notarial Seal the day and year first above written,
(SEAL)
Notary Public for the State of residing at
My
Commission expires 1