I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information
contained in this application from all previous employers, educational institutions, and references. I also
hereby release from liability the potential employer and its representatives for seeking, gathering, and
using such information to make employment decisions and all other persons or organizations for
providing such information.
I understand that any misrepresentation or material omission made by me on this application will be
sufficient cause for cancellation of this application or immediate termination of employment if I am
employed, whenever it may be discovered.
If I am employed, I acknowledge that there is no specified length of employment and that this application
does not constitute an agreement or contract for employment. Accordingly, either I or the employer can
terminate the relationship at will, with or without cause, at any time, so long as there is no violation of
applicable federal or state law.
I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate
against a qualified individual with a disability because of that persons need for a reasonable
accommodation as required by the ADA.
I also understand that if I am employed, I will be required to provide satisfactory proof of identity and
legal work authorization within three days of being hired. Failure to submit such proof within the
required time shall result in immediate termination of employment.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment
under these conditions.