APPLICANT'S DECLARATION
APPLICANT’S NAME:
As part of the application process for employment with The City of Whitehorse (also
sometimes referred to as ("The City"), your signature below confirms you have read
and understood the following, and provided the consents and authorizations set out
below.
1. QUALIFICATIONS - I understand that appointment to any position or
service with The City of Whitehorse is dependent on me:
a. Providing proof of my eligibility to work in Canada; Candidates who are on
work permits, are required to provide original documents.
b. Meeting the job-related standards in the selection process. This may include
job-related knowledge or skill tests, physical ability tests or assessments,
security clearances, driver’s abstracts or medicals.
c. Providing original documents (or Certified Copies) of required job
qualifications. The qualifications I possess which are relevant to or required
for this position are as follows: (list all of your qualifications i.e. certificates,
diplomas, degrees, professional designations, etc. that are required or
relevant for this position.) If original documents are not from Canada or the
United States and a document of Canadian equivalency is available, include
this document in the list.
2. REFERENCES - I authorize the City to contact my references to obtain
information concerning my skills, knowledge, behaviours and performance as
they relate to the competencies for this position. I understand that this information
will be used solely for the purpose of determining my suitability for employment.
3. CRIMINAL RECORD – You may be required to successfully submit a current Police
Information Check including a Vulnerable Sector prior to City employment.
4. RELATIVES EMPLOYED BY THE CITY OF WHITEHORSE – The City
recognizes that all qualified candidates should be provided with the opportunity to be
considered for employment and that family or marital relationships should not unduly
or unfairly restrict an individual’s opportunities to pursue employment in civic
government.
In order to avoid any direct or potential conflict of interest in your employment with
The City, please identify below any relatives, either by family or marriage (including
common-law), that you know are employed with The City of Whitehorse.
This information will be assessed in consultation with Human Resources to determine if your employment
in the position for which you are applying would cause any direct or potential conflict of interest due to
your relationship with the above, as per The City’s Nepotism Administrative Directive 97-04.
5. OVERPAYMENTS – I authorize The City of Whitehorse to recover any
overpayments made to me should I become an employee of The City. All efforts
will be made to provide notice of the overpayment and repayment terms will be
discussed with me.
I certify that all statements, both written and verbal, made in the course of my
application for employment are true. I understand that any misstatements of material
facts may result in my application being rejected or constitute grounds for dismissal.
Candidate’s signature and date Interviewer Signature:
(print name)
The information being collected will be used to gather information about the candidate for consideration of
employment with The City. The information provided will NOT be used for any other purpose(s). If you
have any questions about the collection or the use of this information, please contact Human Resources
at 867-668-8636.