In the following spaces, give a complete record of your employment, including periods of unemployment, if any. Begin with your most recent employment and work back. If additional space is needed, please attach a document at the end of this application.

For clerical and administrative functions only.

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying such information. I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the event that I am hired.

I hereby agree to submit to any lawful drug or integrity testing that may be required as a pre-condition of employment or continued employment.

I understand and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of any wages and salary, be terminated at any time without any prior notice.

I understand that according to federal law, all individuals who are hired must, as a pre-condition of employment, produce certain documentation to verify their identity and U.S. citizen status or if aliens, their legal authorization to work in the U.S. As a consequence, I understand that any offer of employment would be contingent on my ability to produce the required documentation within the period required by law.