Education & Training

High School

College

Additional Training

Work Experience

Business or Professional References (Not Personal)

(List the names of two persons not related to you, whom you have known at least one year)

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying information. I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the event I am hired. I hereby agree to submit to any lawful drug, polygraph, integrity, or skill testing that may be required as a condition of employment or continued employment and understand that unless other wise prohibited by law, refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge. I further agree to submit to search of my person or work area that may be assigned to me and I hereby waive all claims for damages on account of such examination.