Authorization
By entering your (Name of Applicant and Date) and "checking" the (I agree to the Authorization), you are certifying that the facts contained in this application are true and complete to the best of your knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.
You authorize investigation of all statements contained herein and the references and employers listed above to give you any information concerning your previous employment and any pertinent information they may have, person or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
You also understand and agree that no representative of the company has an authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, 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 medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.