I
certify that all of the information provided in this application and
during the interview process is true and complete. I understand that
any misrepresentation or omission of facts called for in this application
or during the interview process is cause for refusal of employment or
immediate dismissal if I have been employed.
I
authorize the investigation of all statements contained in this application
and/or made during the interview process and I release all persons connected
with any such investigation. I authorize you to contact my former employers
regarding my work performance and other information concerning my previous
employment, including the dates of my employment, my job titles and
responsibilities, my compensation, and the reason I am no longer employed
there. I hereby authorize my previous employers to respond to your requests
and to provide you with the requested information, and I release all
persons connected with any such request for information from all claims
and liability which may arise from the release or use of such information.
I also authorize you to contact former education institutions that I
attended regarding my educational performance and other educational
information, including dates of attendance, courses taken, grade and
performance information, graduation information and any other information.
I hereby authorize all such institutions that I identified to respond
to your requests and to provide you with the requested information,
and I release all persons connected with any such request for information
from all claims and liability which may arise from the release or use
of such information. I also authorize an investigation into my driving
record.
I UNDERSTAND THAT NOTHING
CONTAINED IN THIS APPLICATION, OR IN ANYTHING ELSE PROVIDED TO ME, IS
INTENDED TO CREATE, NOR SHALL BE CONSTRUED AS CREATING, AN EXPRESS OR
IMPLIED CONTRACT OR GUARANTEE OF EMPLOYMENT FOR A DEFINITE OR INDEFINITE
TERM. I UNDERSTAND THAT IF I AM HIRED I WILL BE AN AT-WILL EMPLOYEE
AND THAT BOTH I AND MY EMPLOYER WILL HAVE THE RIGHT TO TERMINATE MY
EMPLOYMENT AT ANY TIME, WITH OR WITHOUT NOTICE OR CAUSE, FOR ANY OR
NO REASON.
I
also understand that as part of the hiring process, or as a condition
of my employment, and at any time during my employment, I may be required
to submit to drug and alcohol screening, and I agree to submit to such
examinations/tests. I hereby release all individuals and my employer
from all liability arising from such testing and/or the decisions made
based on such testing. I further understand that employment may be conditioned
upon my passing a job-related physical examination. I authorize any
physician or medical service provider to release any information that
may be necessary to determine my ability to perform the essential functions
of the job for which I am being considered or any future job.
If
I am accepted for employment, I understand that I would be expected
to devote my energies to the fullest extent possible and refrain from
other business interests that might require significant time or would
be considered a conflict of interest. I also understand that if hired,
my employment is contingent on my successful compliance with all employment
eligibility verification requirements of the Immigration Reform and
Control Act of 1986, and any amendments thereto.
If
hired, I authorize my employer to deduct from my wages any amounts which
may be due it as a result of overpayment of wages, loss or destruction
of its property or any other amounts which I may lawfully owe it, or
for which I have received consideration.
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This is to inform you
that as part of the procedure for processing your employment application,
or in the event that you are employed, at any time while you are employed,
your employer may obtain from a credit reporting agency a consumer report
or an investigative consumer report containing financial and other information
about you. The employer may obtain one or more consumer reports regarding
you from one or more consumer reporting agencies and may use the information
provided in this report(s) for any employment purpose, such as evaluating
you for employment, promotion, reassignment or retention as an employee.
A “consumer report” is a communication of information by
a consumer reporting agency bearing on a consumer’s credit worthiness,
credit standing, credit capacity, character, general reputation, personal
characteristics, or mode of living. An “investigative consumer
report” may include information as to your character, general
reputation, personal characteristics and mode of living, and this information
may be obtained through personal interviews with your neighbors, friends
or associates or from others with whom you are acquainted or who may
have knowledge concerning such items of information. This employer complies
with the Fair Credit Reporting Act (and applicable state law) which
provides prospective or current employees with rights regarding consumer
reports and which places specific obligations on employers who obtain
such reports.
I hereby authorize the employer to order a consumer report or an
investigative consumer report containing financial and other information
about me from a consumer reporting agency as part of its investigation
into my application for employment or at any time while I am employed
by the employer. This authorization does not include the release of
my medical information. I hereby authorize custodians of such records
to release such information upon request by the employer or any authorized
representative of the employer, including a consumer reporting agency.
I hereby release and discharge the employer, its employees, agents
and representatives, and any person or entity furnishing oral or written
reports, documents, records or other information, from any and all
claims and liability arising out of or relating to any such background
check, investigation, or out of or relating to the furnishing, inspection
or use of such oral or written reports, documents, records and any
other information pertaining to the above. Additionally, I hereby
acknowledge that I have read the information contained in this disclosure
statement and have understood it. |
