I certify that the answers given by me in this Application and/or Background Information Disclosure (BID) are true and correct without omissions of any kind. I understand that any misleading or incorrect statements may render this Application and/or BID void and may preclude an offer of employment or may result in a withdrawal of an employment offer. If I am employed and it is subsequently discovered that any answer given by me is incomplete, misleading, or incorrect, I may be terminated because of false, incomplete, or misleading statements, answers, or omissions made by me in this application and/or BID. I agree that Lafayette County shall not be held liable in any request; if an offer of employment is precluded or my employment is terminated because of false, incomplete, or misleading statements, answers, or omissions made by me in this application and/or BID.
I understand that I may be required to provide a completed DHFS Background Information Disclosure (BID) for HFS-64; and that Lafayette County may conduct a DOJ Criminal History Record Request, to verify the information given on that form. I further understand that Lafayette County may conduct a Circuit Court (CCAP) record check; an HHS Office of Inspector General (OIG), excluded individual record check; WI Sex Offender Registry Inquiry; applicable Professional Licensure or Certification verification(s); and an Out-of-State Criminal Background Check for anyone who is residing or has resided outside of Wisconsin in the last 3 years preceding the date of the inquiry. Military Discharge papers (DD-214) may also required to be submitted for any employee, who has been discharged from the military within the three (3) years preceding the records search process.
By signing this agreement, I authorize pertinent companies, schools, agencies, municipalities, or persons to give to Lafayette County any information requested regarding my employment history, character, experience, and qualifications and/or suitability for employment with Lafayette County; including, a check of my fingerprints, if requested, and police record(s) for the purpose of considering my suitability for hire. I hereby forever release, discharge, and covenant not to sue any person or organization for any result of providing, obtaining, or acting upon such information. I understand that such information is sought with confidentiality and will not be released to me in any form whatsoever.
The only exception to the above stated non-release of records is the Crime Information Bureau records (CIB) records. Lafayette County issues this notification that you as a current employee, prospective employee or volunteer have the right to obtain a copy of your criminal history records, if any; and acknowledges your right to challenge the accuracy and completeness of any information contained in the criminal history record; and to obtain a determination as to the validity of such challenge before final determination regarding employment/association is made by Lafayette County. Any investigations conducted, reporting, and/or employment requirements imposed under Federal or State law do not in any way impede or affect Lafayette County’s rights under applicable State employment law and/or Lafayette County Policy to deny employment.
A copy of this authorization is as valid as the original and should be recognized as such. In signing this agreement; I acknowledge that I understand that I may be asked to undergo a physical examination, which may include a substance abuse screening, prior to an appointment to a position with Lafayette County; and that I may be asked to undergo said examinations and screening periodically during employment as directed by the Lafayette County Substance Abuse Policy. Any refusal to participate in said substance abuse screening either prior to an appointment to a position with Lafayette County or during employment will result in the rejection of my application and/or termination of employment.
