List below three persons not related to you who have knowledge of your work performance within the last
three years.
Applicant’s Statement & Agreement
I hereby declare that the information provided by me in this Application for Employment (and in any in resume) is true, correct and complete to the best of my knowledge. I authorize Company (or its designee) to investigate my past and present employment, education and activities and verify all data provided by me on this application, on related papers and in interviews. I authorize all individuals, schools and/or firms named herein (except my current employer, if so noted) to provide any information requested about me. I release from all liability any persons, companies, corporations or educational institutions supplying such information. I release the Company (or its designee) from any and all liability resulting from the verification of such information. I understand that any false statement or material omission on this application, or on any supporting documents, shall be grounds for non-hire or discharge, regardless of when discovered by the Company.
Work Rules. In the event of my employment with Company, I agree to comply with all rules and regulations of Company.
Drug/Alcohol Test. I understand that Company reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment to the extent permitted by law.
Medical Examination. I understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of any physical examination or related tests to the Company. I understand that should I decline
to sign this consent or decline to take any of the above-described tests, my application for employment may be rejected or my employment may be terminated.
Background Investigation. I understand that Company’s consideration of my application includes an investigation of the information I have provided on this application and other relevant information such as my driving record,, if any. I understand that should I decline to consent to such an investigation, my application for employment may be rejected or my
employment may be terminated.
Arbitration Agreement. I understand that as a condition of employment, I will be asked to sign an arbitration agreement. I understand that should I decline to sign an arbitration agreement, my application for employment may be rejected or my employment may be terminated.
At Will Employment. If hired, I further agree as follows: My employment and compensation are terminable at will, are for no definite period, and my employment and compensation may be terminated by Company (employer) at any time and for any reason whatsoever, with or without good cause at the option of either Company or myself. No implied, oral or written agreements contrary to the express language of this agreement are valid unless they are in writing and signed by the President of the Company. This agreement takes the place of all prior and contemporaneous agreements, representations, and understandings between me and Company. I understand that if I am offered employment at Company, I will be required to provide evidence of my identity and authorization for employment in the United States.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to to complete the required employment eligibility verification document form upon hire.
The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local “Fair Chance” laws.