I declare that this application was completed by me and that all statements and answers in this application are true and complete to the best of my knowledge. By completing this application, I give the employer the permission to validate my answers with the appropriate authorities. I authorize the employer to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I authorize this employer or its agents to investigate my references, to review my former employment records and to keep and preserve records of such investigations. Additionally, I release all parties from all liability in responding to inquiries and releasing information in connection with my application to this employer or its agents. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to review information provided by previous employer(s), have errors in the information corrected by previous employer(s) and for those previous employer(s) to re-send the corrected information to the prospective employer, and have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information. I agree that in the event of my employment, any untrue or misleading answer, omission, concealment or failure to answer any questions fully, completely and accurately may be grounds for terminating my employment, regardless of when it is discovered. I understand that I am required to abide by all rules and regulations of the Company. I understand that a pre-employment drug screen and background check will be required prior to commencing work as an employee of Ralph’s Moving & Storage. The drug screen results must be negative as a condition of my employment with Ralph’s Moving and Storage. If the drug screen result is positive, Ralph’s Moving & Storage reserves the right to deny employment. Ralph’s Moving & Storage reserves the right to terminate employment based on the results of the drug screen and background check. I hereby authorize Ralph’s Moving & Storage to run motor vehicle reports as needed prior to or during my employment. I further acknowledge for a failed drug screen or background check, that I will reimburse Ralph’s Moving & Storage for the cost of those tests.