Employment Verification Form printable pdf download

EMPLOYMENT VERIFICATION FORM

(to be completed after a Contingent Offer of Employment has been made/accepted)

VERIFICATION OF INFORMATION:

I certify that all information provided on any employment application form, resume, or vita is complete, true and accurate to the best

of my knowledge. I also understand that information may be verified and any misrepresentation of facts may be considered cause for

dismissal regardless of when discovered by the University.

CRIMINAL HISTORY CHECK:

Have you ever been convicted of a felony or misdemeanor?

Yes

Are there any felony charges pending against you?

Yes

If yes, list date(s), type of offense(s), circumstances, county where conviction occurred and action taken:

____________________________________________________________________________________________________________

Conviction of a crime will not necessarily render you ineligible for a position (or to volunteer), but the nature of the conviction,

circumstances and/or time of the occurrence may be considered in processing your application. Criminal conviction will be

considered in relation to the position for which you have applied.

I understand that if I am hired, I may be discharged for any misrepresentation or omission in the above stated information.

I also understand that any job offer or subsequent employment may be conditioned on the University’s receipt of a

satisfactory Criminal Conviction Report.

If determined necessary by the University, I authorize a background check with respect to criminal convictions.

If a third party agency is used to conduct a criminal history check, the University agrees to comply with the Fair Credit

Reporting Act (FCRA).

REFERENCE CHECK:

In accordance with policy and practice the University may inquire and verify any information contained on the application, resume and/or vita as

part of the application process. I understand that my current and former employers may release any information contained in my personnel file or

otherwise known by them to Central Michigan University in connection with my application for employment with Central Michigan University. I

specifically release from liability any current or former employers, their agents, representatives, employees, officers, or directors, for giving such

information to Central Michigan University.

"CMU, an AA/EO institution, is strongly and actively committed to increasing diversity and providing equal opportunity within its community. CMU does

not discriminate in employment against persons based on age, color, disability, gender, familial status, height, marital status, national origin, political

persuasion, race, religion, sexual orientation, veteran status, or weight (see )."

The information requested is needed to help the University assess your employment qualifications. Michigan law requires that a

person with a disability or handicap requiring accommodation to perform the essential duties of the job must notify the employer in

writing within 182 days from the date that the need is known or should have been known.

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Signature (First, Middle, Last)

Print (First, Middle, Last)

Date

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