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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.
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