Applicant Statement
I certify that all information I have provided in order to apply for and secure work with the 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 othenivise verify the accuracy of all information provided by me in
this application. resume orjob 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 a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not
heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill
out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior
notice, and the employer reserves the same right to terminate my employment at any time, with or without
cause and with or without prior notice, except as may be required by law. This application does not constitute
an agreement or contract for employment for any specified period or definite duration. I understand that no
supervisor or representative of the employer is authorized to make any assurances to the contrary and that no
implied oral or written agreements contrary to the foregoing express language are valid unless they are in
writing and signed by the employer's president.
i also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in
the United States and that federal immigration laws require me to complete an l-9 Form in this regard.
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 STATEMENT
