I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) or material fact on this application or on any document used to secure employment can be grounds for rejection of my application or, if I am employed by this Company, terms for my immediate termination from the Company.

I understand that my employment is conditioned on a background check. I permit the Company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my personal experiences with them without giving me prior notice of such disclosure. In addition, I release the Company, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such examination or revelation.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

If I am offered employment, I understand that I may be requested to submit to a medical examination and drug/alcohol test before starting work and agree to comply. If employed, I also agree to submit to a medical examination or drug/alcohol test at any time deemed appropriate by the Company and as permitted by the law. I consent to such examination and authorize the examining doctor to disclose to the Company the results of the examination, which results shall remain confidential and segregated to the personnel file. I understand that my employment or continued employment to the extent permitted by law is contingent upon satisfactory medical examination and drug/alcohol testing, and if I am hired, a condition of my employment will be that I abide by the Company’s drug and alcohol policy.

I understand that this form does not indicate there is a position open and does not obligate the Company in any way. If hired, I agree to adhere to Company work rules, policies, and procedures. The Company retains the right to revise its work rules, policies, procedures, and benefits in whole or in part at any time.