I certify that the statements I have made
are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause
for rejection or dismissal from employment. I authorize obtaining information from any person(s), employers, educational
institutions, licensing authorities, and/or law enforcement agencies concerning
my background, work habits, skill or conduct on the job, with the exception
of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages
for issuing such information.
When I am employed I agree that if at
any time I make claims for personal
injuries, I will submit myself, upon written request, to examination by a physician or physicians of
at employer's expense, as often as may be
I also agree that if I am employed, now
or at any time in the future, my employment may be terminated at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date
of my termination. I understand the term of my employment shall be limited to the duration of any assignment
that I accept.
I am aware that Public Law 91-508, known as the Fair Credit Reporting
Act, requires the employer to inform me that a routine inquiry may be made that will provide applicable information concerning
my character, my general reputation, my personal characteristics and my credit history. Upon written request, I will provide additional information
as to the nature and scope of the inquiry or any report which is
I understand that I am applying for temporary or contract assignments. The completion of the
this application process shall constitute a conditional
offer of employment subject to my availability and the availability of customer assignments calling for the skill and qualifications that I
possess, and I agree to consider acceptance of such assignments.