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Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Submit additional email if you do not have enough room. Be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.
Please select the department you are applying to. This will ensure the correct department receives your application.
Upload resume - MS Word or PDF format recommended
Upload cover letter- MS Word or PDF format recommended
(If you are hired, you may be required to submit proof of age.)
(Include any plea of “guilty” or “no contest.” Exclude minor traffic infractions.)
(A conviction will not necessarily disqualify an applicant for employment.)
(Please include CDL information if applicable.)
Please note that the hiring department may request additional information including, but not limited to, previous work history and education.
Please type your initials in the box to indicate that you have read and understand that the County may request additional information.
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission
may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school,
current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring
decision. I release and hold harmless such persons and organizations from any legal liability in making such statements.
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug
screen as a condition of employment, if required.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment
physical examination and background check. I consent to the release of any or all medical and criminal information as may be deemed
necessary to judge my capability to do the work for which I am applying.
I understand and agree that if I am required to operate a motor vehicle as part of my job duties as a San Miguel County employee, as a
condition of employment that San Miguel County is authorized to obtain and continue to monitor my driving records. The standards for
operating a motor vehicle for San Miguel County are as follows: The applicant must posses a valid license to operate the type and class of
vehicle they will be permitted or required to drive. The applicant must have no restrictions that would prevent them from legally or safely
operating the assigned vehicle. Where applicable, the applicant must present a current DOT Physical Examination Card and a Certification of a
Road Test. Applicant must have no convictions for misdemeanor traffic offenses within the previous 3-year period. Misdemeanor traffic
offenses include but are not limited to DUI, DWI, vehicular homicide, reckless driving, hit and run, or other offenses that would indicate
flagrant disregard for public safety. Applicant must have no more than two at-fault or chargeable accidents within the previous 3-year period.
Applicant must have no more than three traffic infractions in the previous twelve month period.
I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT
EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE
EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE BOARD OF COUNTY COMMISSIONERS (“BOARD”)
OR THE COUNTY ADMINISTRATOR HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR
ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE BOARD OR COUNTY
ADMINISTRATOR AND THE EMPLOYEE.
I have read, understand, and by my signature consent to these statements
As part of our hiring process, San Miguel County may request Consumer Reports and/or Investigative Consumer
Reports on you from an Investigative Reporting Consumer Reporting Agency solely for your potential/current and or
continued employment with this company. The nature and scope of this investigation may include but is not limited to
your employment history, education, credit history, criminal history,
character, general reputation, personal characteristics and mode of living and may involve a review of criminal records
and records of the Department of Motor Vehicles. San Miguel County may obtain one or more consumer reports on
you, from one or more consumer reporting agencies, for the purpose of evaluating you for employment, and, if the
undersigned is already employed by this company, for purposes of
promotion, reassignment, or retention as an employee.
The name of the Investigative Consumer Reporting Agency conducting this consumer report/investigative consumer
report is: DataCheck, Inc., 63 Via Pico Plaza PMB #247, San Clemente, CA 92672, PH: 800-253-3394. Their website
address is: www.datacheckinc.com. You many find DataCheck's privacy practices, including whether your personal
information will be sent outside of the United States or its territories, and
information that complies with California Civil Code subsection 1786.20, on their website under Privacy Policies.
You are being given a copy of the "Summary of Your Rights Under the Fair Credit Reporting Act" prepared pursuant
to 15 U.S.C. section 181 (g & c). You have the right to request additional disclosures of the nature and scope of the
investigation and a statement of your rights.
I have read and understand the foregoing and hereby authorize this company to obtain one or more consumer reports on
me for the purposes described above. I understand that this authorization covers (1) consumer reports obtained in
connection with my application for employment and (2) if I am hired or if I am an existing employee, additional
consumer reports may be obtained during my tenure. I authorize that a copy of
this authorization may be considered as valid as an original
Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W.,
Washington, DC 20552.
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies.
There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about
check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA.
For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection
Bureau, 1700 G Street N.W., Washington, DC 20552.
You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny
your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name,
address, and phone number of the agency that provided the information.
You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency
(your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the
disclosure will be free. You are entitled to a free file disclosure if:
• a person has taken adverse action against you because of information in your credit report
• you are the victim of identity theft and place a fraud alert in your file
• your file contains inaccurate information as a result of fraud
• you are on public assistance
• you are unemployed but expect to apply for employment within 60 days
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide
specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.
You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit
bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans,
but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report
it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an
explanation of dispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete or unverifiable information. Inaccurate, incomplete or unverifiable
information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has
verified as accurate.
Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative
information that is more than seven years old, or bankruptcies that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an
application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.
You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your
employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry.
For more information, go to www.consumerfinance.gov/learnmore.
You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers
for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers
are based on. You may opt out with the nationwide credit bureaus at 1-888-567-8688.
You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to
a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For more information, visit
States may enforce the FCRA and many states have their own consumer reporting laws. In some cases, you may have more rights under state
law. For more information, contact your state or local consumer protection agency or your state Attorney General.
For information about your federal rights, contact:
1. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates
Consumer Financial Protection Bureau
1700 G Street NW
Washington, DC 20552
Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB:
Federal Trade Commission: Consumer Response Center - FCRA
Washington, DC 20580
2. To the extent not included in item 1 above
National Banks, federal savings associations, and federal branches and federal agencies of foreign banks.
Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
State member banks, branches, and agencies of foreign banks (other than federal branches, federal agencies, and insured state branches of foreign
banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal
Federal Reserve Consumer Help Center
P.O. Box 1200
Minneapolis, MN 55480
Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations.
FDIC Consumer Response Center
1100 Walnut Street, Box #11
Kansas City, MO 64106
Federal Credit Unions.
National Credit Union Administration
Office of Consumer Protection (OCP)
Division of Consumer Compliance and Outreach (DCCO)
1775 Duke Street, Alexandria, VA 22314
3. Air carriers
Asst. General Counsel for Aviation Enforcement & Proceedings
Aviation Consumer Protection Division
Department of Transportation
1200 New Jersey Avenue S.E., Washington, DC 20590
4. Creditors Subject to Surface Transportation Board
Office of Proceedings, Surface Transportation Board
Department of Transportation
395 E. Street S.W., Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act, 1921
Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies
Associate Deputy Administrator for Capital Access
United States Small Business Administration
409 Third Street, SW, 8th Floor
Washington, DC 20416
7. Brokers and Dealers
Securities and Exchange Commission
100 F St NE Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations
Farm Credit Administration
1501 Farm Credit Drive
McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors not listed above.
FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center – FCRA
Washington, DC 20580
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