PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I hereby certify that the statements contained in this application are true and complete to the best of my knowledge and
that no attempt has been made to conceal pertinent information. I further understand that, in the event I am employed by
the Company, falsified statements entered in this application, or the omission of material information from this
application or during the interview process, shall be grounds for disciplinary action up to and including termination of
I authorize the investigation of all statements contained in this application and further authorize the references listed to
release information concerning my previous employment. All parties, including the Company, are released from all
liability on any claims that result from furnishing such information to the Company.
It is understood that if, after I have submitted this application to the company, any changes occur which affect the
accuracy of the information entered herein, it shall be my responsibility to inform the Company of such changes prior to
I understand that any offer of employment made may be contingent on my submission to a medical examination
(including a drug test). It is understood that the results of such an examination will be kept confidential. I also
understand that if I am offered employment by the company that it will be on an at-will basis
I understand that a photocopy of this certification is authorization as effective as the original.