Subjects of special study/research work or special training/skills
U.S Military or Naval Service
Rank
Former Employers(List below last four employers, starting with last one first)
Date
Name & Address of employer
Salary
Position
Reason for leaving
References- Give below the names of three persons not related to you, whom you have known at least one year.
Name
Address
Business
Years known
Authorization
“I
certify that the facts contained in this application are true and
complete to the best of my knowledge and understand that if employed,
falsified statements on this application shall be grounds for dismissal.
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 such information.
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 agreements contrary to the
foregoing, unless it is in writing and signed by an authorized company
representative.
This waiver 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.”
