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I hereby affirm that the
information provided on this application form (and accompanying resume, if any)
is true and complete to the best of my knowledge and agree to advise this
Company, in writing, of any change or addition to any information contained in
this application. I agree that false information or the omission of information
from this Application (including leaving blanks on this Application or my
failure to correct or add to the information changes during the course of my
employment) ("Inaccurate Information") may disqualify me from
consideration for employment or continued employment and may well result in my
immediate dismissal if discovered at a later date. I further agree to hold
harmless and indemnify the property and this Company from any and all liability
that may be caused by the Company relying on Inaccurate Information.
I authorize the investigation of
my past employment and other qualifications of employment as deemed appropriate
and agree to cooperate in such investigation. I agree to release, indemnify and
hold harmless all persons and other entities (third parties) providing the
information requested by the Company. I also agree to release, indemnify and
hold harmless the Company from any and all liability in connection with its
conducting such investigation as it deems appropriate and the use of the
information received from Third Parties.
I understand that if am hired,
my employment with the Company may be terminated, with or without cause, at any
time at the discretion of either the Company or myself. I understand that if I
am accepted for employment with the Company, the Company reserves the right to
change my job responsibilities, wages, benefits and any other term or condition
of my employment with the Company at any time to meet the needs of the Company,
subject to applicable federal and state laws.
This employment application is
used to notify me that the nature and scope of an investigation, if one is
conducted, could include such general identification information as residence
verification, and, as applicable, information concerning my employment,
education, credit record, general reputation, character, personal
characteristics, and habits, and such information may be developed through
personal interviews with third parties such as family members, neighbors,
friends, associates, former employers, financial sources and custodians of
official records. Only job related information developed from such a report
will be considered in evaluating my employment application or continued
employment.
I release this Company from all
liability for damages from issuing truthful information and authorize any and
all listed references, former schools, employers and their agents and employees
to provide truthful information regarding my employment, character and
qualifications.
By entering my name and today's
date below and submitting this form, I am indicating that I have read the above
statement and understand its content, intent and terms.
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