If you've been in an accident over the last 3 years, please provide (below) information related to the accident:
If you received and Traffic Convictions and/or Forfeitures in the last 3 years (other than parking violations) please describe below:
I certify that I have read and understand all of the employment application. It is agreed and understood that the employer or his agents may investigate the applicant's background and employment history to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of his furnishing such information. I understand that, as an applicant for a positive with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in rejection or dismissal.
If hired, I agree to abide be all the rules and policies of the employer.
This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.