Employment Application Form

Please read the following statements carefully before signing this application. Only those applications that are complete, signed and dated are considered valid.
▪ I hereby declare that the information provided by me in this application is true and complete. I understand that falsification or
omission of any information is grounds for refusal to hire, or if hired, grounds for termination.
▪ If I am hired, I agree to comply with all rules, procedures, and policies of the Supervisor of Elections and to work overtime as
requested. I understand that these rules, procedures, and policies may be changed, interpreted, withdrawn, or added to by the
Supervisor of Elections at any time, at the Supervisor’s sole option and without any prior notice to me.
▪ I authorize any of the persons or organizations referenced in this application to release any and all information concerning my
previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the
subjects covered by this application. I release all such parties from all liability for any damage, which may result from furnishing
such information.
▪ I authorize you to request, receive and verify all information given in this application.
▪ I further acknowledge that if I am employed by the Orange County Supervisor of Elections, my employment will be at will, and may
be terminated with or without cause, at any time, by me or the Supervisor of Elections.
▪ I understand that satisfactory completion of a pre-employment physical examination and drug test is a mandatory condition of
employment. A positive confirmed drug test or the refusal to submit to a drug test will result in the conditional offer of employment
being withdrawn and will render the applicant ineligible for employment for a minimum of twelve (12) calendar months from the
date of the positive drug test.
▪ I understand that I may be requested to submit to a drug and alcohol test at any time, including, but not limited to a situation in
which management determines that there is reasonable suspicion that my judgment, performance, or behavior may be impaired
due to the presence of drugs or alcohol in my system while conducting or engaging in business for the Supervisor of Elections, or
if I am involved in an accident during work hours. Positive results can affect my eligibility for workers’ compensation benefits and
can lead to disciplinary action up to and including immediate dismissal from employment.
▪ I understand that I will be asked to provide specific information and documentation that will be utilized to conduct a background
investigation.
▪ I have read and understand the above statements