Release and Waiver

APPLICANT’S NAME:__________________________________        DATE:______________

Important: Please read carefully and initial each paragraph before signing.

By my signature and initials placed below, I promise the information provided in the employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, if discovered at a later date. I agree to immediately notify Chenowith Water PUD (hereinafter referred to as CWPUD) if I should be convicted of a felony, or any crime involving dishonesty or a breach or trust while my job application is pending, or during my period of employment, if hired.

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I authorize the investigation of all statements contained in this application and accompanying resume, if any. I also authorize CWPUD to contact my present employer (unless otherwise noted in this application), past employers, listed references and any other person or entity with knowledge of me. I understand that if my position is one, which warrants such an inquiry, CWPUD may request an investigative consumer report from a consumer reporting agency that includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that the investigative consumer report may involve personal interviews with my neighbors, friends, relatives, former employers, schools, and others. I also understand that under the Federal Fair Credit Reporting Act I have the right to make a written request to CWPUD, within a reasonable time, for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.

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I authorize any person, school, current employer (except as previously noted), past employer(s), and organizations named in this application form and accompanying resume, if any, and any other person or entity with knowledge of me to provide CWPUD with any information and opinion which CWPUD regards as useful to it in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements or furnishing any and all information which CWPUD may seek.

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I understand that part of the hiring process for employment with CWPUD includes testing for controlled substances. I also recognize that the results of an analysis of such specimen will be provided to CWPUD and will be used to determine suitability for employment. In addition, I understand that if I fail to pass the pre-employment drug test or I refuse to take such test I cannot be considered for employment.

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I agree to consent to take such test at such time as designated by CWPUD, and I agree to release CWPUD, its councilors, officers, agents or employees from any claim arising in connection with the tests and the use of such tests.

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I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD OF TIME, and may, regardless of the date of payment of my wage or salary, BE TERMINATED AT ANY TIME, subject to CWPUD ordinances and rights provided by written contract.

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Signature Date