to the best of my knowledge. I understand that falsification of this information
may prevent me from being hired or lead to my dismissal if hired.
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 agreement 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.
I understand that a criminal record check and registry checks may be necessary
prior to my employment. If a criminal records check is required, I understand that
the company will obtain a separate written authorization from me to consent to
the criminal records check, which includes information regarding the use of the
In compliance with federal law, all persons hired will be required and eligibility to
work in the United States and to complete the required employment eligibility
verification document form upon hire.