Employee Certification Statement
I authorize the Employer to investigate my personal employment history and I authorize any current/former employer, person, firm, corporation, or government agency to give the Employer any information regarding my employment history.
If I should be offered a position, I understand that a criminal information records check will be conducted on me. (A criminal record does not constitute an automatic bar to employment. Non-felony convictions will be considered only if the circumstances substantially relate to the particular job in question.)
In consideration of the Employer's review of this application, I release from all liability and/or legal claims the Employer and every person seeking or providing information, whether it be oral or written. A photocopy of this release shall be as valid as the original, and may be relied upon by all persons providing information.
Further, I certify that all information on this application is true, complete, and correct to the best of my knowledge. I understand that any false or misleading statements made by me, or material omissions of information requested of me, shall constitute grounds for rejection of my application, or if employed, my immediate dismissal.
If employed, I agree to comply with all the rules and regulations of the Employer. I also understand that employment is subject to the satisfactory investigation of the application and a favorable physical examination report, including a screening questionnaire for tuberculosis approved by the department of health services and, if indicated, a test to determine the presence or absence of tuberculosis in a communicable form.