3
May we contact your previous supervisor for a reference?
Military Service
If other than honorable, explain:
Disclaimer and Signature
I certify that all information I have provided in order to apply for and secure work with the employer is true,
complete and correct. I understand that any information provided by me that is found to be false, incomplete or
misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii)
immediately discharge me from the employer’s service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and
obtain information from all references (personal and professional), employers, public agencies, licensing
authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in
this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the
employers, its agents, employees or representatives, for seeking, gathering and using such information in the
employment process and all other persons, corporations or organizations for furnishing such information about
me.
I understand that the employer does not unlawfully discriminate in employment and no question on this
application is used for the purpose of limiting or excluding any application from consideration for employment on a
basis prohibited by applicable local, state or federal law.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and
the employer reserves the same right to terminate my employment at any time, with or without cause and without
prior notice, except as may be required by law. This application does not constitute an agreement or contract for
employment for any specific period or defined duration. I understand that no supervisor or reprehensive of the
employer is authorized to make any assurance to the contrary and that no implied, oral or written agreements
contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s
partners.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the
United States and that federal immigration laws require me to complete an I-9 Form in this regard.