(Supply Name and Address of Your Last Three Employers, Dates Employed, Salary, Position and Duties, and Reason for Leaving)
Anything else you would like to tell us:
In submitting this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I understand that if this application results in a subsequent personal interview for employment that I will be asked to furnish certain references concerning my work history. I understand that prior to employment that you will conduct any investigation necessary concerning any part of my background related to the position I am seeking, including, but not limited to, the obtaining of a police report and driving record. I understand and agree that, if employed, I will be responsible for familiarizing myself with all rules and regulations of the company as they presently exist or are later modified and that I will abide by its rules and regulations which I understand are subject to change. I also understand that no representative of the company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time.