TRADE, BUSINESS, OR CORRESPONDENCE
Former EmployersList below your last three employers, starting with the last one first.
ReferencesGive below the names of three persons not related to you, whom you have known at least one year.
Authorization and ReleaseI 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 and employers listed above to give you any and all information concerning my previous employment and any pertinent information that may have, personal or otherwise, and release the company from all liability for any damage that may result from.
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 of time, to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
In connection with my application for employment, I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination for termination of past employment. I understand that as directed by company policy and my workers compensation injuries, driving record, court record, education, credentials, credit, and references.
Medical and workers' compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA), and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied be of information obtained with y prospective employer from a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information.
I hearby authorize without reservation, any law enforcement agency, institution, information service bureau school, employer, reference or insurance company contacted by Nicole Marie Enterprises, LLC pre-employment screen agency, to furnish the information described above.
The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes.
Known Criminal History Filings