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Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.
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
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.
This wavier does not permit the release or use of disability-related or medical information in a manner prohibited
by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
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