REASON FOR LEAVING
** Hours of Availability: Please list what days and time of day you are available to work
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 the employers listed below 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 damages 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 forgoing 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 manor prohibited by the American’s with Disabilities Act (ADA) and other relevant federal and state laws.