Applicant Consent to Release Liability and Reference Information

In consideration of employment with Ak-Chin Indian Community(ACIC) , I hereby authorize Ak-Chin Indian Community to perform background checks, reference checks and employment verifications on me. These checks may include, but are not limited to discussions with: supervisors, coworkers, business associates, or any other party who Ak-Chin Indian Community in its sole discretion, believes may have relevant job related information regarding my suitability for employment. AkChin Indian Community may also verify information that I have provided on the completed employment application and/or resume.

I agree not to assert any demands, damages, claims, suits or causes of action of any kind against Ak-Chin Indian Community, its offenders, employees, agents or the organizations, officers, employees, and agents contacted arising out of Ak-Chin Indian Community performing a good faith effort to check my employment references.

I acknowledge that my failure to authorize Ak-Chin Indian Community to check my references shall disqualify me from consideration from employment. I acknowledge, Ak-Chin Indian Community has made no representation that employment will be offered to me upon the completion of reference checks.

I understand the position I am applying for may require a satisfactory background check.

I acknowledge that employment at Ak-Chin Indian Community may be conditioned upon satisfactory completion of a screening test for the presence of controlled substances. Upon reasonable suspicion, Ak-Chin Indian Community may require that I participate in further urinalysis screening tests for the presence of controlled substances.

I also acknowledge that if the position requires driving in the course of work, I understand that I will be required to possess a current and valid driver's license and understand that I will be required to provide a copy of my driving record.

I hereby verify, under the penalty of perjury, the information contained in this application is true, correct, and complete to the best of my knowledge and belief. I am aware that, should an investigation at any time disclose misrepresentation or falsification, my application will be rejected, and I may be dismissed from employment and disqualified from future employment with Ak-Chin Indian Community. The Community has my permission to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history or credit standing. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the Community.

I understand that this application does not constitute an employment contract of any kind. Should I be employed by Ak-Chin Indian Community, I may resign such employment at any time at my discretion with or without prior notice, and the Community may terminate my employment at any time at their discretion, with or without cause and with or without proper notice

A photocopy or facsimile (fax) of this form that shows my signature shall be as valid as the original.

I UNDERSTAND THAT THIS APPLICATION IS VALID ONLY FOR THE POSITION APPLIED.