Notice to Applicant: We are an equal opportunity employer and do not discriminate on the basis of an applicant’s or employee’s race, color, religion, sex, national origin, citizenship, age; physical or mental disability or any other characteristic.

I hereby certify that the information contained in this application form and an any attachments listed below (hereafter made a part of this application) is true and correct to the best of my knowledge and agree to have any of the statements checked by the organization unless I have indicated to the contrary. I authorize the references listed above to provide the company any and all information concerning my previous employment and any pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the company as well as from the use or disclosure of such information by the organization or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or mental omission of information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.