APPLICANT’S CERTIFICATION AND AGREEMENT
PLEASE READ CAREFULLY
1. Certification of Truthfulness I certify that all statements on this Application for Employment (and accompanying resume and notes, if any) are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed, or
if employed may result in my dismissal.
2. Authorization for Employment/Educational Information
I authorize the references listed in this Application for Employment, and any prior employer, educational institution, or any other persons or organizations to give this Company any and all information concerning my previous employment/educational accomplishments,
disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization.
3. Employment at Will
If I am hired, in consideration of my employment, I agree to
abide by the rules and policies of this Company, including any changes made from time to time, and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or other representative of the Company, other than the President, has any authority to enter into any agreement for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the President must be made in writing to be effective.
4. Authorization to Work
If I am selected for hire, I will be offered employment provided I verify that I am authorized to work as required by the Immigration Reform and Control Act of 1986.
5. Limitation on Claim I agree that any action or suit against the Company arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought within six (6) months (or the minimum time that a court of competent jurisdiction finds to be reasonable) of the event giving rise to the claim or be forever barred. I waive any statute of limitations to the contrary.
6. Need for Accommodation
If I am a handicapper who requires an accommodation to
perform the job, I must notify the Company of that need within 182 days after I knew or reasonably should have known that an accommodation was needed. Failure to do so
will bar me from alleging that the Company has not accommodated me as required by law
7. Criminal Records Check
I agree to execute an authorization for this employer to secure criminal conviction history from the appropriate law enforcement agency, should the Company determine it is necessary to do so.
8. Physical Exam and Drug and Alcohol Testing
I agree to take a physical exam and authorize the Company or its designated agent(s) to withdraw specimen(s) of my blood, urine or hair for chemical analysis. One purpose of this analysis is to determine or exclude the presence of alcohol, drugs or other substances. I understand that decisions concerning my employment will be made as a result of this test.
9. Credit Report
I understand that the Company may request a consumer report or an investigative consumer report, including information as to my character, general
reputation, personal characteristics and mode of living for general purposes of evaluating my application for employment. I further understand that I may request in writing from the Company a complete and accurate disclosure of the nature and scope of the investigation requested. I consent to the furnishing of such report to the
Company.
10. Consideration of Employment
I understand that my application will be considered pursuant to the Company’s normal procedures for a period of thirty (30) days. If I am still interested in employment thereafter, I must reapply.
I have read and understand items one through eleven above and acknowledge that with
my signature below. I agree that if any of the above commitments is ever found to be legally unenforceable as written, the commitment concerned shall be limited to allow its enforcement as far as legally possible.
