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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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