Add at least two schools.

Add at least two employers.

Add at least 2 professional references.

**Indicates that you have read, understand, and agree to the Authorization statements below.

AUTHORIZATION: I hereby certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.