If you worked in any of your previous positions under another name, please give that name(s) below: (For reference checking purposes)

Give three references, not relatives or former employers.

By entering name and date below and submitting this form, I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

I hereby authorize the Company to contact any company or individual as it deems appropriate to investigate my employment history, character and qualification and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for libel, slander, defamation, invasion of privacy or any other reason because of their statements.

I agree that, if employed, I will abide by all the rules and regulations of the Company. I understand that the taking of drug and alcohol tests, when given pursuant to company policy, are a condition of continue employment and refusal to take such tests when asked will be ground for immediate termination. I further understand that nobody in the the Company is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the President of the Company. I also understand that my employment is at-will and may be terminated by myself or by the company at any time for any reason or no reason at all, with or without prior notice.