In case of an emergency, notify:
TRAINING / EDUCATION / SKILLS / INTERESTS
(PLEASE LIST MOST RECENT FIRST, OR ATTACH RESUME)
List below three references (not a relative or former employer) whom you have known for at least five years
Please read the following carefully. Your signature below is required, and acknowledges that you have read, understood and agreed to the information.
I affirm that the information contained in this application is true, complete, and accurate. I authorize investigation of all statements contained in this application form if I am considered for employment. I also authorize previous employers, personal references named, or any other person whom the company may contact, to give any and all information regarding my employment or any other information, personal or otherwise, that may or may not be on their records. I fully release all persons and entities from any and all liability or potential claims resulting from the disclosure, use or
dissemination of any such information whether it is favorable or unfavorable.
I understand that misrepresentation or material omission of the facts called for herein or receipt of unsatisfactory references may result in disqualification from employment, or, if I am hired, my dismissal from employment. I also understand that any job that I am offered will not be for any set period of time. My employment may be terminated at any time of my own free will or the will of my employer.