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If you have a physical or mental disability which substantially limits one or more of your major life activities (i.e., seeing, hearing, speaking, breathing, learning, working), you are not required to disclose information about the disability.  HOWEVER, the City will make reasonable accommodations for the disability of an otherwise qualified candidate.

If you want the City to consider special arrangements to accommodate a disability during the application and selection process, including testing, please: 

            (1)        identify the disability in the space provided below,

 AND

            (2)        suggest the kind of accommodation that you believe would be appropriate.

To avoid unnecessary delay, please submit your request and documentation of the need for accommodation at least 48 hours in advance of the time the accommodation is needed.  The request to the Human Resources Department may be in writing, by telephone, or in person.

Telephone:  501-371-4590       Voice/TDD:  501-371-4405

NOTE:  THE INFORMATION PROVIDED ON THIS FORM WILL BE KEPT SEPARATE FROM THE EMPLOYMENT APPLICATION FORM.  THE INFORMATION WILL REMAIN STRICTLY CONFIDENTIAL.  DISCLOSURE WILL BE MADE ONLY TO THOSE PERSONS NECESSARY TO AID IN DETERMINING AND IMPLEMENTING THE REASONABLE ACCOMMODATION.

I understand that failure to complete this form accurately and thoroughly may result in disqualification.

I understand that should an investigation disclose misrepresentation of falsification of any information on this form or its attachments, my application may be rejected, my name removed from an eligible register, and if I am already employed, I may be dismissed from City employment, and I may be disqualified from applying for future employment with the CITY OF LITTLE ROCK.

I understand that a medical examination may be required if I am offered employment for the position for which I am applying.  I also understand that the position for which I have applied may require a screening test for drugs and alcohol.

I understand that this electronic application, and any other documents I have received in connection with my application, does not constitute a contract of employment either collectively or singularly.  I further understand that, should I be selected for employment with the City of Little Rock, the terms and conditions of my employment are governed by the Administrative Personnel Policy and Procedure Manual, and if applicable, the Rules and Regulations of the Little Rock Civil Service Commission.

I understand that my electronic application for employment once submitted to Human Resources is subject to disclosure as a public record under the Arkansas Freedom of Act upon request by a citizen of the state of Arkansas.

I, for the purpose of determining my acceptability for employment, I understand that by submitting this application electronically I am authorizing any of the persons or organizations referenced in this application, application supplement, or resume' to give the City of Little Rock any and all information concerning any previous employment, education, or any other information that might have personal or otherwise, with regard to any of the subjects covered in these application documents or relevant to this application process. By submitting this application electronically,  I release all such parties and the City of Little Rock from all liability for any damage that may result from furnishing such information, and  I authorize the City of Little Rock to request and receive such information.  Electronic storage of this data shall be deemed effective and shall be in effect for one year from today's date.

By electronically submitting this application, I am certifying that:

1. I understand and acknowledge the pre-employment conditions listed in this section;
2. I authorize relevant information, as addressed in this section to be provided to the City; and
3. My application form and all attachments/supplements contain no false information and are complete, truthful and accurate to the best of my knowledge.

* I have read all application requirements and understand that I am responsible for completing and submitting any additional documentation required on the job application.