EMPLOYMENT

NOTE: do not fill out any part of this section you believe to be non-job related.

PLEASE NOTE: Your application WILL NOT BE considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if necessary. FOR EMPLOYERS OUTHSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.

Include only individuals familiar with your work ability. DO NOT include relatives or names of supervisors listed above.

NOTE: Do not fill out any part of this section you believe to be non-job related.

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumers reporting bureaus, to verify any of this information. I release all former employers, persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.