If you are to be hired by the company, you will be required to attest to your identity
and employment eligibility, and to present documents confirming your identity and employment eligibility.
You cannot be hired if you cannot comply with these requirements.
AUTHORIZATION
I certify that the facts contained in this application (and accompanying resume, if any) are true and
complete to the best of my knowledge. I understand that any false statement, omission, or
misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no
matter when discovered by the Company.
I understand that any employment is conditioned on a background check. I authorize the Company to
thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and
references to disclose information regarding my former employment, character and general reputation to the
Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former
employers and all references listed above from any and all claims, demands or liabilities arising out of
or related to such investigation or disclosure.
I understand and agree that nothing contained in this application, or conveyed during any
interview, is intended to create and employment contract. I future understand and agree that if I am
hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with
or without cause and without prior notice, at the option of either myself or the Company. No promises
regarding employment have been made to me, and I understand that no such promise or guarantee is
binding upon the Company unless made in writing by an authorized Company representative.
If I am offered employment I agree to submit to medical examination and drug test, if required, before
starting work. If employed, I also agree to submit to a medical examination or drug test at any time
deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and
I request that the examining doctor disclose to the Company the results of the examination, which results
shall remain confidential and segregated from my personal file. I understand that my employment or
continued employment, to the extent permitted by law, is contingent upon satisfactory medical
examinations and drug test if required, and if I am hired a condition of my employment will be that I abide by the
Company’s Drug and Alcohol Policy.
I understand that acceptance of this form does not indicate there is a position open and does not
obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The
Company retains the right to revise it policies or procedures, in whole or in part, at any time.
