I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct.
I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal
and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by
me in this application, resumé, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or
representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons,
corporations, or organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating
any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.
I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment.
My personal information may be shared with the employer’s affiliate(s) and third parties engaged by the employer to perform services for the employer. Any
personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.
This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding
an applicant from consideration for employment on the basis of his or her race, color, religion, national origin, sex (including pregnancy), sexual orientation, gender
identity, ancestry, place of birth, age, physical or mental condition, genetic information, or any other protected status under applicable federal, state, or local law.
I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me
from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.
Do not sign until you have read the above applicant statement.
I certify that I have read, fully understand and accept all term of the foregoing Applicant Statement
Signature of Applicant Date