Please list your last four employers,
starting with the most recent.
Give the names of three persons not related to
you, whom you have known at least one year.
Do you have any physical limitations that preclude you from performing any work for which
you are being considered?
"I certify that the facts contained in this
application are true and complete to the best of my knowledge and understand that, if employed, falsified
statements on this application shall be grounds for dismissal. I authorize investigation of all statements
contained herein and the references listed above to give you any and all information concerning my
previous employment and any pertinent information they may have, personal or otherwise, and release all
parties from all liability for any damage that may result from furnishing same to you. I understand and
agree that, if hired, my employment is for no definite period and may, regardless of the date of payment
of my wages and salary, be terminated at any time without prior notice. I understand that employment is
contingent on background, DMV, and drug/alcohol screens pertaining to the job for which I am applying."