Begin with most recent employer. Attach additional sheet if needed.
I certify that all of my answers giver here are trueand complete to the best of my knowledge, and that supplying false information herein shall result in immediate disqualification for employment or termination from employment, regardless of when such false information is discovered.
I authorize investigation of all statements contained in tis application for employment as may be necessary in arriving at an employment decision; and I hereby agree to indemnify and hold harmless each and every current or prior employer in defending against any charge, complaint or suit filed with any Federal, State or local agency, or in any court of the State or Federal government for providing an accurate, factual history of employment information.
I undestand that neither this document nor any offer of employment from the constitutes an employment contract, unless a specific document to that effect effect is executed by the employer and employee in writing.