Full Name

Street Address

I hereby authorize the Company to obtain an investigative consumer report, which may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional information concerning the nature and scope of any such investigation. I further authorize the Company to investigate all of the information on this application and to contact any previous employer or other reference I have provided; and I hereby release such employer and other reference from any and all liability whatsoever by reason of furnishing such information to the Company and any agent acting on its behalf. I hereby certify that I have read and understand the questions posed on this application, and that each of my responses is true and complete. I understand, further, that the Company is relying on my responses and that any misrepresentation or omission to state a material fact will constitute cause for cancellation of this application, or discharge if I am employed. I understand and agree that in the event of my employment by the Company, my status will be that of an EMPLOYEE AT WILL and that I have no contractual right, expressed or implied, to remain an employee of the Company. In consideration of my employment, I agree to abide by the rules and regulation of the Company and agree that my employment and compensation can be terminated with or without cause, and without notice, at any time, and at the option of the Company or myself. I understand that no representative of the Company other than the President or the Director of Human Resources has the authority to make any agreement contrary to the foregoing. In further consideration of my employment, I understand that I will be required, before I commence employment, to sign a confidentiality agreement protecting the Company's information and I hereby agree to sign such agreement and to review the policy statement as a condition of my employment. I further understand that I may be required, as a condition of my continued employment, to sign other agreements and policy statements prepared by the Company from time to time.