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Authorization:
I certify that the facts contained in this application
are true and complete to the best of my knowledge
and understand that, if employed, falsified statements
on this application shall be grounds for dismissal.
I authorize investigation of all statements contained
herein and the references and employers listed above
to give you any and all information concerning my
previous employment and any pertinent information
they may have, personal or otherwise, and release
the company from all liability for any damage that
may result from utilization of such information.
I also understand and agree that no representative
of the company has any authority to enter into any
agreement for employment for any specified period
of time, or to make any agreement contrary to the
foregoing, unless it is in writing and signed by an
authorized company representative.
This waiver does not permit the release or use of
disability-related or medical information in a manner
prohibited by the Americans with Disabilities Act
(ADA) and other relevant federal and state laws.
Digital Signature:
Date:
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