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***If unemployed, type NONE
***Include employment dates, name, phone,and address of employer, supervisor name, type of business, positions held, assigned duties, and reason for leaving.
explain or put n/a
***A check mark indicates a Yes response to the question above
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
By checking the "I agree" box below, I the undersigned, certify that I have read and understand this application in its entirety and
that the information herein provided is true and complete to the best of my knowledge. I
understand that should any statement made by me during the hiring process prove false,
misleading or erroneous, may result in the rejection of my application and/or discharge from
the Easton Police Department. In submitting this application, I further understand that it
becomes the property of the Town of Easton Government and will not be returned.
EASTON POLICE DEPARTMENT
AUTHORIZATION FOR RELEASE OF INFORMATION
I, , DO HEREBY AUTHORIZE a review
of a full disclosure of ALL records, or any part thereof, concerning myself, by a duly authorized agent
of the EASTON TOWN POLICE DEPARTMENT, whether said records are of a public, private or
THE INTENT OF THIS AUTHORIZATION is to give my consent for FULL AND COMPLETE
disclosure of the records of educational institutions, financial or credit institutions, including records of
deposits, withdrawals and balances of checking and savings accounts and loans, and also the
records of commercial or retail agencies (including credit reports and/or credit ratings); medical and/or
psychiatric treatment and/or consultation(s), including hospitals, clinics, private practitioners, and the
United States Veterans’ Administration; public utility companies; employment and pre-employment
records, including background reports and polygraph examination results, efficiency ratings,
complaints and/or grievances filed by me or against me, and salary records; real and personal
property records, and other financial statements and records, where-ever filed; records of complaint,
arrest, trial and/or convictions for alleged or actual violations of law, including criminal and/or traffic
records, records of complaints of civil nature made by me or against me, wheresoever located, and to
include the records and recollections of attorneys at law, or of other counsel, whether representing me
or another person in any case in which I presently have, or have had an interest.
The Easton Police Department’s acquisition, retention, and sharing of information related to your
employment application is generally authorized under (state and federal citations). The purpose for
requesting this information is to conduct a complete background investigation pertaining to your
fitness to serve as an employee. This background investigation may include inquiries pertaining to
your (employment) (education) (medical history) (credit history) (criminal history) and any information
relevant to your character and reputation. By signing this form, you are acknowledging that you have
received notice and have provided consent for The Easton Police Department to use this information
to conduct such a background investigation, which may include the searching of (N-DEx) (criminal
justice databases) (private databases) (public databases).
Specific N-DEx statement:
I authorize any employee or representative of The Easton Police Department to search N-DEx to
obtain information regarding my qualification and fitness to serve as an employee. I understand that
N-DEx is an electronic repository of information from federal, state, local, tribal, and regional criminal
justice entities. This national information sharing system permits users to search and analyze data
from the entire criminal justice cycle, including crime incident and investigation reports; arrests,
booking, and incarceration reports and probation and parole information. This release is executed
with full knowledge, understanding, and consent with any information discovered in N-DEx may be
used for the official purpose of conducting a complete employment background investigation. I also
understand that any information found in N-Dex will not be disclosed to any other person or agency
unless authorized and consistent with applicable law. I release The Easton Police Departments from
any liability or damage that may result from the use of information obtained from N-DEx.
I REITERATE AND EMPHASIZE that the intent of this authorization is to provide FULL AND FREE
access to the background and history of my personal life, for the specific purpose of pursuing a
background investigation which may provide pertinent data for the EASTON TOWN POLICE
DEPARTMENT to consider in determining my suitability for employment by said agency. It is my
specific intent to provide access to personal information, however personal or confidential it may
appear to be, and the source(s) of information specifically identified herein.
I UNDERSTAND THAT ANY INFORMATION OBTAINED by a personal history background
investigation which is developed directly or indirectly, in whole or in part, upon this authorization for
release of information will be considered in determining my suitability for employment by the EASTON
EPD - 021 (1) 19
TOWN POLICE DEPARTMENT.
I AGREE TO INDEMNIFY AND HOLD HARMLESS the person(s) to whom this request is presented
and his/her agents and employees, from and against ALL CLAIMS, damages, losses and expenses,
including reasonable attorney’s fees arising out of or by reason(s) of complying with this request.
I FURTHER UNDERSTAND that in the event my employment application and/or resume is
disapproved and/or not considered for employment, the sources of confidential information CANNOT
BE RELEASED AND/OR REVEALED to me.
IT IS FURTHER UNDERSTOOD by me that a photocopy of this release form will be valid as an
original hereof, even though the said photocopy does not contain an original writing of my signature.
It is understood and agreed that I am required to successfully complete the approved
Maryland Police Training Commission course (Police Academy). Failure to complete this
course may result in the applicant's immediate dismissal from the Easton Police
Applicant, if hired, is required to serve a two-year probationary period from date of
appointment, during which time his/her services may be terminated at the discretion of the
Chief of Police.
This field is not part of the form submission.
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