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HomeMy WebLinkAboutAdministrative Order No. 2009-11 Fire Department Background Investigation Procedures e K CO. Administrative Order No. 2009-11 Fire Department Background Investigation Procedures Effective December 10, 2009 The City of Bozeman Hiring Procedures Manual is hereby amended to reflect changes to the Fire Department Background Investigation Procedures. In adopting the Bozeman Fire Department post conditional offer process policy, we are revoking pages 24 through 27 of the City of Bozeman Hiring Procedures, which were adopted by Admin Order 2009-07 on October 13, 2009. My previous Administrative Order No. 2009-07 entitled "City of Bozeman Hiring Procedures" is hereby amended. This Administrative Order is effective immediately and shall remain in effect until revoked in writing by me. DATED this 10`h day of December, 2009. Chris A. Kukulski, City Manager Fire Department - Post Conditional Job Offer Back round Investi anon Procedure As part of the preliminary screening process, the Employment Specialist has already conducted a search of the publicly available sexual and violent offender registries, convicted felon and probation/parole websites in the states where the applicant has resided (as indicated on the Application.) Interviews have been held and a eligibility list has been created, and the top candidates from this list have received verbal and written conditional offers of employment. Within the Fire Department,the post-conditional offer process is conducted by the Fire Chief or the Deputy Chief Operations. Additional assistance is provided by George Watson, PhD of Bozeman Psychological Services and Dr. Robert Hathaway, of Bozeman Deaconess Medical Associates. The Post-conditional offer process for Probationary Firefighters involves several steps, these steps are divided into two separate days. DAY ONE: Initial Meeting - The Fire Department background investigation begins when the successful candidates are invited to meet, in a group setting, with the Fire Chief, and Deputy Chief Operations. Prior to beginning the process described below the candidate is given another copy of their conditional job offer letter. At this meeting, the candidates are congratulated on reaching this step in the hiring process, and are told about the background investigation process and the steps it includes. They are told that the City is not looking for perfect people but that the City is looking for honest people. They are told that individuals can make mistakes through life, and that the City asks that they be honest about those mistakes. The Candidates are also told that if, through this process the City finds out they have not been honest, they will automatically be disqualified. Applicant Waiver-Packets -At this point, Applicant Waiver Packets are provided to each candidate, which include the forms described below. Each form is read out loud to the candidates (word for word, with the candidates following along) by the Chief, or Deputy Chief Operations and candidates are given an opportunity to ask any questions (in the group setting or in private) pertaining to these documents prior to signing. Each of these documents allows the Department to complete the rest of the background investigation and/or is used to verify information in the Personal History Questionnaire. Letter of Understanding- This document describes the extensive background investigation process and the information we will be looking at. Certification and Penalty-Document signed by the candidate stating the s/he will tell the truth in the investigation and notifying the applicant that a misstatement of material fact, willful omission of material fact or willful deception will be cause for disqualification and rejection as a candidate for employment or grounds for termination after employment. Authorization to Release Information &Release from Liability-This form is used for the candidate to give permission to other agencies to release information to our investigators about the candidate's involvement with other employment. This form also states that we will not release any information about our investigation to anyone, including the candidate. Pre-Employment Investigation Discovery Waiver- Form stating the investigators will not release the information found in the investigation to the candidate so the candidate cannot retaliate against anyone for giving information about the candidate. Fair Credit Reporting- This form authorizes the city to request a credit report on the candidate. This report is used to demonstrate financial responsibility. This is important as firefighters often sign for supplies for the department, make purchases at local businesses, are in businesses and residences where cash and other valuables may be readily accessible, etc. Subject to Fair Credit Reporting Act . Internet Disclosure Form -The Fire Department will do a search of all publically accessible Internet information. This purpose of this form is to ensure that the candidate is aware we will be doing this search. Tattoo and body Piercing Disclosure- Tattoos and piercings are acceptable as long as they would not be offensive to our customers or would violate safety protocols (e.g., tattoos depicting nudity on an arm or leg, rings in the nose, etc.) Department policy states that if a candidate has any of these they will be required to have them covered while on duty. ,Johnson Roberts Questionnaire -This "bubble sheet" questionnaire is used to begin Dr. Watson's work on the psychological evaluation. There are two versions of the Johnson Roberts questionnaire, Pre Offer and Post Offer. The Fire Department uses the Post Offer questionnaire which asks the applicant behavior-based questions ranging from alcohol use, Fire Department experience, behavior and physical altercations, drug abuse, marital background, to criminal and driving record questions. Many of the questions are similar to those asked in other interviews, history statements etc. In addition to sharing the responses with Dr Watson to use in his work, the Fire Department uses this portion of the background investigation to look for disclosures, omissions and conflicting information, behavior patterns etc. which are followed up during the rest of the background check process, including when talking to the candidate. This questionnaire is completed at the fire station during the initial meeting. Personal History Questionnaire-This is a questionnaire on which the candidate provides basic identification information as well as information about past work history, military history, education, references and acquaintances. This Questionnaire allows the Department to gather information needed to complete the background investigation, and is also used by Dr. Watson during the psychological evaluation. This is take home questionnaire filled out at the candidate's convenience at home and mailed back to the department within I4 days. DA Y TWO. Psychological Evaluation—The work of a firefighter involves long stretches away from home, and exposure to stressful incidents, often in harsh conditions. The purpose of a psychological evaluation is to make sure a candidate can function well under these conditions, and will and can work well with other members of the Department. During day two, applicants meet with Dr. George Watson of Bozeman Psychological Services and complete the following tool: • MMPI-2 - Minnesota Multiphasic Personality Inventory-This personality inventory helps Dr. Watson discover what the applicant is like as a person. The MMPI-2 helps identify how the candidate typically feels, thinks and behaves and may also identify any psychological problems and issues relevant to the candidate. • Personality Assessment Inventory for Law Enforcement Corrections and Public Safety Selection (PAI) - This tool contrasts the applicant's characteristics against those of other firefighter/EMT's who have successfully completed the screening procedures for the same position, were hired, and completed at least one year in that position. Once the above tool is completed candidates are given three other tests that are take home tests to be completed online and on bubble sheets as described below. • DISC Inventory—This is a tool Dr. Watson uses to learn about the applicant's behavioral strengths and weaknesses, motivating and demotivating factors, emotional reactions, and interpersonal preferences. This is a 15 minute online test taken at the candidates convenience at home. • RBA - Role Behavior Anal -This tool is used in conjunction with the results of the DISC results, and compares the applicant's characteristics/behaviors with those behaviors/characteristics that have been found to indicate success as a Bozeman firefighter, This is a 15 minute online test taken at the candidates convenience at home. • Firefighter Lifestyle Assessment and Medical Examination (FLAME) - The Firefighter Lifestyle Assessment and Mental Examination (FLAME) is a self-report questionnaire designed by Frank C. Seitz, Ph.D., a Clinical and Forensic Psychologist, in concert with the Bozeman Fire Department. Dr. Seitz worked with the Bozeman Public Safety Division for for decades. The FLAME consists of nine pages of opened-ended questions relating to the following areas: (1) Medical history; (2) Education; (3) Employment; (4) Marriage/Family; (5) Legal history; (6) Substance use; (7) Personality; and (8) Firefighting experience, attitudes, strengths and weaknesses, The FLAME data provided by the applicant is used as part of a personal interview conducted by Dr. Watson. This test is a bubble sheet type of test that is taken at home, at the candidate's convenience, and returned to Dr. Watson for scoring. Phone Conference with Dr. Watson - After the above tests are completed, and the results of the Johnson Roberts Questionnaire have been received by the Department and sent to Dr. Watson, a private appointment follows with Dr. Watson, often by phone, during which the candidate and Dr. Watson discuss the results of these tests/inventories, and Dr. Watson gathers any other information he needs to complete his evaluation. Final Psychological Report_- Based on the information received as a result of the testing and phone interview process, Dr. Watson prepares a final report which addresses the candidate's suitability for employment as a Firefighter, and provides recommendations for the most effective way to interact with and train that candidate. Final steps to the Background.Investigation Process completer)by the Fire Chief or Deputy Chief Operations Verification of Background Information - The Chief or Deputy Chief Operations undertake the steps needed to verify the information the candidates have provided during the Application and Selection process and at the initial meeting described above. This includes: • Additional reference checks are conducted, to confirm the applicant conducts him/herself on and off duty in a manner consistent with the Bozeman Fire Department's Code of Conduct and Oath of Office. • Human Resources runs ScreenNow Criminal Background and Credit Check Reports, which are subject to the Fair Credit Reporting Act requirements. Final Interview -A Final Interview is scheduled with each candidate to discuss any issues that are identified during the background investigation that require clarification or explanation. For example, if the background check reveals a prior job that the candidate has omitted on the Application or revealed in the Personal History Questionnaire, the Applicant is given the opportunity during the Final Interview to explain the omission. The information the Applicant provides during the Final Interview is subject to further verification and is considered at the time the decision is made whether to accept or reject the candidate for employment. Candidates that successfully complete the Background Investigation Process proceed to the Pre- Employment Medical Exam and Fitness for Duty Determination process described below. Pre-Employment Medical Exam and Fitness for Duty Determination - Only those who have been cleared by the Department's physician, Dr. Robert Hathaway, are allowed to be employed as a firefighter with the City of Bozeman. Dr. Hathaway conducts all Department medical examinations using the standards set forth in National Fire Protection Association Standard 15 82: 9andard on Comprehensive Occupational Medical Program,for Fire Departments. In completing his assessment of the candidate's fitness to perform the duties of a firefighter, Dr. Hathaway also considers the reports of the vision exam, and the hearing assessment. A fitness for duty determination is provided only after Dr. Hathaway has reviewed all the pertinent reports. Once a candidate has been declared ft for duty, Dr. Hathaway sends the Human Resources Director via the Fire Chief a letter, stating that the applicant is fit for duty. No medically-related information is included in this letter: It simply states that the applicant is fit for duty as a firefighter. Final Recommendation -The final recommendation to hire or disqualify the candidate is based upon all information in the investigation file and a comprehensive review of hiring standards and issues. The Fire Chief has the final decision on hiring recommendations to the Human Resources Department. Upon satisfactory completion of the above process and Human Resources' receipt of relevant reports, the post conditional offer process is complete. Human Resources sends a letter to the candidate, confirming that s/he has satisfactorily completed the conditional offer elements, and the Fire Department schedules the candidate for his/her first day of work. TEMPLATE OFFER LETTER FOR FIRE DEPARTMENT CANDIDATES DATE NAME ADDRESS CITY, STATE ZIP Dear NAME: Congratulations! Through this letter,the City of Bozeman conditionally offers you the position of Probationary Firefighter with the Bozeman Fire Department. Please contact Chief Jason Shrauger at (406)582-2350 as soon as possible to discuss this conditional offer and to begin the background and reference check process described below. In addition, you are scheduled to meet with Fire Chief Jason Shrauger at Fire Station 91 (34 North Rouse Ave.) on XXXXXX at X:XX Xm. It is important for you to understand his offer of employment is conditional upon the successful completion of: (i) an extensive background and reference check to be conducted by the Bozeman Fire Department; and(ii)several pre-employment medical examinations(a schedule and description of these medical appointments is enclosed). The City of Bozeman conditions employment on a thorough background and reference check because the city has both a legal and ethical obligation to ensure all firefighters have strong personal and professional traits;to make that determination the city understands a person`s past behavior and reputation are critical indicators of a person's future conduct and decision making ability. The following considerations are critical in determining the scope of the background check that will be conducted for you. First, a simple tenet of the position you are a finalist for: firefighters must completely and without hesitation rely upon each other in life and death situations. Second, firefighters undeniably hold a position of public trust that carries great authority and responsibility in the community.The potential to serve in amanner that upholds and builds this trust is evident in the personal character and history of each candidate.Third,firefighters have access to the most personal details of our citizens, including private medical information. Related to this is the fact that firefighters are invited by our citizens into their homes and businesses with nothing but trust that a firefighter will serve and protect. Lastly, medical evaluations are necessary to ensure you are not only physically capable of doing all the required duties but also to determine you are mentally fit to protect the public and your fellow firefighters. Given the above, the city has a duty to ensure the candidates who are hired into the firefighting team are women and men of integrity and honesty. That's why we conduct thorough background and reference checks on all candidates. The Fire Chief will, at your meeting on XXXXXX, ask you to fill out several forms to assist in this process. These forms are attached to this letter and include, among others,the following: • A Letter of Understanding that details the scope of the background and reference check that will be conducted for you as well as the types of medical evaluations you will be required to undergo; • A Pre-Employment Investigation Discovery Waiver of your right to know and view the information compiled during the background check except where the information obtained may related to a serious medical condition (this protects those who provide information about you from possible retaliation); • An Authorization to Release Information and Release from Liability that authorizes the City of Bozeman to obtain information from your past employers and others who may have important information about you and a release from Iiability for those who do so(this allows others to release information that may implicate your rights without concern for legal implications); • A Certification and Penalty that recognizes all statements made by you during the background review must be truthful;if not,you candidacy or employment may be terminated by the City; • Consent to allow the City of Bozeman to conduct a federal Fair Credit Reporting Act investigation; • An internet disclosure that indicates the City of Bozeman will complete a search of all publically available internet information that concerns you; and • A tattoo and body piercing disclosure. The Letter of Understanding and the packet of forms described above are included along with this Ietter for your reference. Please do not fill these out at this time. They are being provided for you now to allow you sufficient time to review and evaluate prior to your initial meeting with the Fire Chief. Please understand the City of Bozeman will require you complete these forms at this first meeting. While the City of Bozeman desires to afford some flexibility in the background check process and may agree to certain deviations the City has a legal duty to ensure the process is fair and equitable for all participants. If you do not agree to aspects of the process or have specific questions related to the forms please contact the Fire Chief prior to your initial meeting. Further details regarding the background and reference check will be discussed at your initial meeting. At the conclusion of this process,the Fire Chief will provide you with a written statement indicating whether the conditions described above have been met. If so, you will be officially hired as a Probationary Firefighter.The Fire Chief has the sole discretion to determine whether the above items have been satisfactorily completed. Your first day of employment with the City of Bozeman will be provided to you at that time. You should report to Fire Station#1 at 8:00 a.m. on your first day of employment, and ask for Fire Chief Jason Shrauger. Please note, this position is established with a twelve (12) month probationary period. Conditional Offer November 30,2009 Page 3 In addition, should you be finally hired as a probationary firefighter, the current entry level pay for the position is$X,XXX per month,paid as earned,with an increase to$X,XXX per month,paid as earned, after satisfactory completion of your first 6 months of employment. You will also receive $XX per month,as earned,for your EMT-Immediate/Paramedic Certification. This is a non-exempt position under the Fair Labor Standards Act and,as such,is entitled to overtime pay or compensatory time in Iieu of overtime pay, at time and a half, for each hour worked when qualifying work hours exceed the maximum hours allowed under the 207(k)work schedule in effect at the time ofthe work being performed. The Bozeman Fire Department relies on off-duty personnel and call-back to provide direct life-safety services to the City of Bozeman. Therefore, the department has determined that a time-based response requirement is in the best interest of the City and has implemented a Residency Requirement for its department personnel. The policy requires employees to live within a local fire district (see attached map). Finally, should you be finally hired as a probationary firefighter„ sometime during your f rst three days of employment, you will be provided with New Employee Orientation with Employment Specialist Stacy Randle. She will contact you on your first day to set up an appointment. Enclosed is a document which details the information you will need to bring with you to orientation in order to complete the paperwork. To make this process run smoothly, please come prepared with all necessary information as detailed on the enclosed City of Bozeman new Employee Orientation— Documents Needed. Please provide original documents only. Also enclosed is a Benefit Summary Sheet, which describes the benefits that are offered to other similarly situated employees. Please review the information and bring any questions you have to orientation,where they will be answered. In the meantime,please indicate your acceptance of this conditional offer by signing this letter and returning it to me. A copy of this letter is enclosed for your records. If you have any questions, please do not hesitate to contact me at (406) 582-2346 or pbergn4bozeman.net. Congratulations! Sincerely, I accept the above-described conditional offer of employment as Probationary Firefighter with the City of Bozeman, Montana. PATRICIA J. BERG, SPHR Human Resources Director NAME Date enc. Copy of this letter for your records Pre-Employment Exams&Appointments Probationary Firefighter Class Specification AUTHORIZATION TO RELEASE INFORMATION AND RELEASE FROM LIABILITY This should be changed to include"Letter of Understanding and Other Background and Reference Check Forms.We may also wish to specifically list each here). Conditional Offer November30,2009 Page 4 City of Bozeman—Fire Department Residency Map City of Bozeman New Employee Orientation-Documents Needed Benefit Summary Sheet xe: File Jason Shrauger, Fire Chief Terry Clark,Payroll Officer Bozeman Fire Department Background Investigation Tracking Sheet Name of Applicant: Name of Investigator: Background Investigation Initial/Support Documents Date Mail/Requested By Date Received B Personal History Statement Johnson Roberts Questionnaire Credit Report Wanted Person (Local/CJIN) Crim History (Local,NCIC,CJIN) Driver's License Check/History DL States Checked: Other Agencies/Information Personal Interview with Applicant - at a.m/p.m. Reviewed Personal History Statement (in detail) Reviewed Johnson Roberts Questionnaire Results Reviewed"first hand" Credit Report Documents Verified Document Date/By Documents Date/By Birth Date/Birth Certificate Selective Service/Military Educational Requirements Driver's License 1 Bozeman Fire Department Background Investigation Tracking Sheet Reference Checks Completed Personal Phone Fax Letter Reply Name Contact Contact Contact Mailed Received B Personal References Military References Neighbors/Landlords Background Report Completed for Chief s Approval: Investigator's Signature: 2 0 LETTER OF UNDERSTANDING I recognize l have been given and have accepted a conditional offer of employment with the Bozeman Fire Department. l understand that there are certain requirements 1 must meet before 1 can be finally hired by the Department. I understand that I must submit to an extensive background investigation, which consists of the following areas of concern, at a minimum: • A review of my completed Personal History Statement; • An evaluation of a Johnson/Roberts Personal History Questionnaire; • A thorough criminal background check; • A thorough examination of prior employment • An examination of my personal credit report; • A thorough examination of publically accessible internet information; and • A psychological examination. A Background Investigator from the Department will evaluate the results of these investigation tools and make a preliminary decision as to my suitability for employment, which will be followed by completion of some or all of the following tests, depending on the position being sought: • Medical examination; • Hearing test; and • Vision test. 1 recognize the aforementioned background reviews, evaluations, examinations, and tests will be administered in a manner selected by the Department. I understand the results of the tests are the property of the Department and 1 will not receive copies of the reports nor any information contained in them, except as it may relate to a serious condition discovered by the examining physician. A final verification of the background information and interview with the investigator will complete this process after such time a final decision whether to officially hire will be made by the Fire Chief. I agree to assist in the expedient conclusion of these reviews and examinations. I understand successful completion of this process does not guarantee employment with the City of Bozeman, only that I will be considered for positions as they become available, pursuant to established rules and regulations of the City of Bozeman. l have read and understand the content and purpose of this Letter of Understanding. I agree to abide by these requirements as a condition of my candidacy for employment with the City of Bozeman. Signature of Applicant DATE: Subscribed and Sworn before me the day of ' 20 Notary Public in and for said County of Notary Public Certification and Penalty f, do hereby declare that all statements and information provide to the Bozeman Fire Department in the Personal History Statement and any other statements and information provided for my pre-employment background investigation or any other phase of my pre- employment screening, are true and complete to the best of my knowledge and belief. 1 understand that any misstatement or willful omission of material fact, or willful deception, will be cause for disqualification and rejection as a candidate for employment, without appeal. I further understand that these aforementioned misstatements, omissions, or deceptions are also grounds for termination after employment, without notice. I ACKNOWLEDGE I MAY HAVE CERTAIN RIGHTS AND PRIVILEGES UNDER LAW AND l ASSERT l HAVE BEEN GIVEN SUFFICIENT TIME AND OPPORTUNITY TO REVIEW THIS DOCUMENT AND CONSULT WITH ANY PERSON I WISH. I ACT UNDER NO COMPULSION. Dated this day of 120 Signature Print Name NOTARY On this day of , 20 , before me, the undersigned, a Notary Public for the State of Montana 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 13 AUTHORIZATION TO RELEASE INFORMATION AND RELEASE FROM LIABILITY PLEASE READ CAREFULLY,THIS DOCUMENT CONTAINS IMPORTANT INFORMATION REGARDING YOUR RIGHTS UNDER MONTANA LAW. YOU ARE ADVISED YOU MAY CONSULT WITH ANY PERSON YOU WISH REGARDING YOUR LEGAL RIGHTS PRIOR TO SIGNING. As an applicant for a position with the Bozeman Fire Department, I acknowledge the position of probationary firefighter is a position of public trust. To ensure 1 am capable of upholding this public trust, understand the Department must conduct a thorough investigation of my character and background. 1 also understand that I am required to furnish information to the Department and that the Department will inquire of others information about me for its use in determining my qualifications and suitability for employment. I understand and agree the Department should be authorized by me to inquire with others with regards to my behavior, background, and character. In doing so, I understand those who may have information about me should be free to share this information with the Department and 1 fully encourage them to do so. I also believe they should be free from any threat of retaliation for information they provide; as such, I realize and agree the Department will not release any information provided to the Department about me to any person, including myself. To allow the Department to obtain information others may have about me, I knowingly, intelligently, and voluntarily authorize the release to the Department of any and all information of any kind that any person or entity may have concerning me, including information of a confidential or privileged nature. Specifically, and without limitation, I authorize all my previous employers, physicians, and other professionals who may have examined or treated me, my friends, acquaintances, credit reporting services, financial institutions, public agencies, and all others of any kind to furnish to the Department any all information they may have concerning me. in doing so, I hereby release every person, company or organization, or any other entity, from any claim of any kind, whether for liability or damage of any kind, which may result from furnishing the information requested by the Department. I further authorize that a photocopy of this form shall be as valid as the original. 1 authorize every person or entity requested to provide information to the Department about me to retain a copy of this form for their files. I understand I will not receive copies of the reports nor any information contained in them, except as it may relate to a serious condition discovered by the examining physician. AGAIN, I ACKNOWLEDGE 1 MAY HAVE CERTAIN RIGHTS AND PRIVILEGES UNDER LAW AND 1 ASSERT I HAVE BEEN GIVEN SUFFICIENT TIME AND OPPORTUNITY TO REVIEW THIS WAIVER AND CONSULT WITH ANY PERSON I WISH. I ACT UNDER NO COMPULSION. Dated this day of 20, Signature Print Name AUTHORIZATION TO RELEASE INFORMATION AND RELEASE FROM LIABILITY NOTARY On this day of 20_, before me, the undersigned, a Notary Public for the State of Montana 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, 1 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 2 0 Pre-Employment Investigation Discovery Waiver and Hold Harmless Agreement PLEASE READ CAREFULLY. THIS DOCUMENT CONTAINS IMPORTANT INFORMATION REGARDING YOUR RIGHTS UNDER MONTANA LAW. YOU ARE ADVISED YOU MAY CONSULT WITH ANY PERSON YOU WISH REGARDING YOUR LEGAL RIGHTS PRIOR TO SIGNING. As an applicant for a position with the Bozeman Fire Department, I recognize the Department has a legal and ethical obligation to take every reasonable effort to ensure that persons employed by them as firefighters,or in other positions, conform to the very highest standards of honesty and integrity. The Department,concerned about the integrity of their background process and wanting to ensure those who furnish information about me are protected from retaliation against them for information they may provide, wishes to ensure I will NOT be afforded the opportunity to review the information obtained by the Department under any circumstances. I understand Article 2, Section 10 of the Montana Constitution provides me a right to know information held by public entities, including the Bozeman Fire Department: No person shall be deprived of the right to examine documents or to observe the deliberations of all public bodies or agencies of state government and its subdivisions,except in cases in which the demand of individual privacy clearly exceeds the merits of public disclosure. Based on the above, I acknowledge I may have a constitutional right to know the results of the Department's investigation yet I recognize the importance of ensuring those who are asked to provide information about me do so free from any concern of retaliation for information they may provide.As such, having been given the opportunity to discuss this waiver with any person I wish, l voluntarily, knowingly, and intelligently agree to waive my right to know the contents of the background investigation,exceptforthe contents of a consumer credit report created pursuant to the Federal Fair Credit Reporting Act, conducted on me to guarantee those who provide information about me during this investigation do so without any fear or concern for retaliation of any kind and to protect their privacy interests. Having waived this right, I know that all information submitted to the Department,whether by me or any other person or entity will be considered confidential by the Department and will be used only for investigating my suitability for employment as a probationary firefighter and those records, whether I am hired or not, will be maintained by the City of Bozeman pursuant to its record retention schedule and state law. Furthermore, I understand the Department and the City of Bozeman will do everything possible to protect my privacy rights regarding the contents of the background check. Again: I understand I will not receive a copy of any information obtained or developed during this background investigation. In addition, I hereby knowingly,intelligently,and voluntarily,and with full understanding of my rights under law and having been given the opportunity to discuss this waiver with any person I wish, release and hold harmless the Bozeman Fire Department and City of Bozeman and their officers, agents,or assigns, now and in the future,from any claim or damages in law or in equity on behalf of myself, my heirs and assigns, for their refusal to make available any and all of the information contained in this pre-employment investigation,including, but not limited to,the identity(ies)of any person(s) and/or organization(s) which may have supplied information in the course of this investigation, as well as the substance of any information supplied. 1 0 Pre-Employment Investigation Discovery Waiver and Hold Harmless Agreement AGAIN, I ACKNOWLEDGE I MAY HAVE CERTAIN RIGHTS AND PRIVILEGES UNDER LAW AND I ASSERT I HAVE BEEN GIVEN SUFFICIENT TIME AND OPPORTUNITY TO REVIEW THIS WAIVERAND CONSULT WITH ANY PERSON I WISH. I ACT UNDER NO COMPULSION. Dated this day of 20 Signature Print Name NOTARY On this day of 20`, before me, the undersigned, a Notary Public for the State of Montana 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 2 FEDERAL FAIR CREDIT REPORTING ACT Consent to Request Consumer Report Information I understand that the Bozeman Fire Department will utilize the services of a consumer reporting agency as part of the procedure for processing my application for employment. I understand the consumer reporting agency will conduct an investigation which may include obtaining information covering up to the last seven (7) years regarding my credit background, references, character, past employment, work habits, education, general reputation, personal characteristics, mode of living, judgment, liens, and criminal background. I understand such information may be obtained by direct or indirect contact from former employers, schools, financial institutions, landlords and public agencies and through personal interviews with my neighbors, friends and associates, acquaintances or other persons who may have such knowledge. I understand this investigation by a consumer reporting agency is in addition to the investigation conducted by the Department and may include an inquiry into many of the same items, I realize I am waiving my right to obtain information gathered by the Department as evidenced by Pre-Employment Investigation Discovery Waiver, yet, I fully acknowledge I may have an opportunity to review information developed and produced for the Department by a consumer reporting agency. I also understand that before I am denied employment based on information obtained in the report, I will be provided a copy of the report and a description in writing of my rights under the Fair Credit Reporting Act. I understand if I disagree with the accuracy of any information in the report, I must notify the Bozeman Fire Department within two days of my receipt of the report. If I notify the Bozeman Fire Department within two days of the receipt of the report that I am challenging information in the report, the Bozeman Fire Department will not make a final decision on my employment status until after 1 have had a reasonable opportunity to address the information contained in the report. I hereby consent to this investigation and authorize the Bozeman Fire Department to procure a report on my background as stated above from a consumer reporting agency. FULL LEGAL NAME: DOB: SSN: Signature: SUBSCRIBED AND SWORN to before me this day of 20 NOTARY PUBLIC FOR MONTANA Residing at Bozeman My commission expires: 0 Internet Disclosure I am aware that the Bozeman Fire Department will complete a search of all publically accessible internet information that concerns me. By sigg n_g this form I certify that I am aware that the Bozeman Fire Department will conduct this search Signature of Applicant: Date: Printed Name: NOTARY On this day of 20_, before me, the undersigned, a Notary Public for the State of Montana 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_ 1N 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 Tattoo and Body Piercing Disclosure Bozeman Fire Department Uniform Policy 103.01 specifically addresses piercings and tattoos. This policy exists to maintain a high standard of public appearance in and out of the station. The policy specifically states: Piercing: a. Employees will not wear any visible body piercing.jewelry while on duty (i.e: tongue studs, eyebrow studs, nose rings, lip rings, forehead studs, etc.). b. The Fire Chief may authorize the wearing of body piercing jewelry such as ear rings. Tattoos: a. No Tattoos may be visible. b. Tattoos must be covered by the uniform of the division that the individual works in. c. Tattoos must be covered when wearing civilian clothing while on duty. d. The Fire Chief may authorize an individual to have a tattoo uncovered. Please list the type and location of each body piercing. Please provide a written description of each tattoo and its location. In addition., if the tattoo(s) contain letters, numbers, or symbols,please explain the acronym, significance of the numbers, or the meaning of the symbol. Please check the appropriate response below. I do not have tattoos or body piercing. I do have tattoos and/or body piercing, see below list. Description Location Symbolism (Example) USMC Right Shoulder United States Marine Corps (Example) 2 Ear rin s Both ear lobes N/A Signature of Applicant Date