List three (3) persons (not relatives) who have knowledge of your work performance within the last four (4) years.
Below, please describe past or present employment positions.
PLEASE READ AND INITIAL EACH PARAGRAPH, THEN SIGN BELOW
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 or ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure a position can be grounds for rejection of the application or, if I am employed by this company, can be grounds for my immediate expulsion/termination from the company
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 work record and my professional 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.