Please give the names of three persons you are not related to, whom you have known at least one year.
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.
I also acknowledge that this company reserves the right ot require pre-employment and/or random drug
This company is an equal employment opportunity employer. We adhere to a policy of making
employment decisions without regard to race, color, religion, sex, sexual orientation, national origin,
citizenship, age or disability. We assure you that your opportunity for employment with this company
depends solely on your qualifications.