“I certify that the information I have provided in this application is true and complete to the best
of my knowledge and I understand that one or more falsified statements within this application is
grounds for dismissal.

I authorize investigation of all statements contained herein and, the references and employers
listed within to give you any and all information concerning my previous employment and any
pertinent information they may have, personal or otherwise, and I release the company from all
liability for any damage that may result from use of said information.

I also understand and agree that no representative of the company has any authority to enter
into any agreement for employment for any specified period, or to make any agreement contrary to
the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medically-related
information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant
federal and state laws.”