I understand that my employment, if accepted, with the City of Tomah – Tomah Area Ambulance Service, will be on a probationary basis. I further understand that my continued employment will be contingent upon results of that probationary period. I agree to these conditions and hereby certify that all statements made by me on this application are true and that willfully withholding information, or making false statements on this application, will be reason for disqualification as a candidate for employment or cause for termination if I am employed.
I hereby authorize the City of Tomah – Tomah Area Ambulance Service, or its authorized representative, to contact and obtain information pertaining to me from the sources contained in this document and from any of the following (but not limited to) sources:
1. Municipal, State, or Federal Law enforcement Agencies
2. Military Records
3. Any place of business (for the purpose of obtaining employment information)
4. Present employer
5. Any previous employer
6. Any school, college, university, or other educational institution
7. Any office, clinic, or hospital where illness, injuries, and/or deterioration are diagnosed and treated.
I hereby release any individual, agency, or institution, including its officers, employees, or related personnel, both individually and collectively, from any and all liability for damages, of whatever kind, which may at any time result to me, my heirs, family, or associates, because of compliance with this authorization and request to release information, or any attempt to comply with it. Photo Copies of this page are permissible for the purposes of this document.