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 employer's selection, at employer's
expense, as often as may be requested.
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 produced.
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.
Please take a moment to review your application. Indicate that
you have read the above statement by entering your initials in the box below and
creating an electronic signature. To complete this application, click on the
Submit Application button.