Fill and Sign the I Certify that to the Best of My Knowledge and Belief the Statements Form

, INC. AGREEMENT BY APPLICANT All information and answers to questions are true and correct to the best of my knowledge and belief. In consideration for possible employment, I understand that may conduct or authorize another to conduct an investigation into my credit history and personal background. I have been informed that should such and investigation be undertaken, I am entitled upon written request, to receive a copy of any investigative report filed as a result. I request my former employers and their representatives to release all information in their possession which may deem relevant to my application for employment. In exchange for consideration of my application, I also agree to release and hold harmless any former employer, employer representative, or others from liability which he or she my incur in connection with the release of such information.I agree to submit, upon 's request, to a pre-employment physical and medical examination by a physician or physicians designated by at its expense, and also to submit to further physical and mental examinations and testing as , Inc. shall require as a condition of my continued employment. I realize that my employment or continued employment may be conditioned upon the results of such examinations and my willingness to participate in such examinations freely. will attempt to keep all matters regarding such examinations confidential: however, I agree that may disclose to its employees, managers, agents, and others, as it deems necessary, the information gathered during any such examination or test.I also understand that unless sometime in the future I enter into a specific written employment contract with , that the employment relationship between and me is freely terminable at the will of either party for any lawful reason. If employed, I agree to acquaint myself with and to abide by all rules and policies established by . I authorize """ to release to other prospective employers or third parties may information regarding my employment or obtained pursuant to my employment relationship, and I hereby release, acquit, and agree to hold harmless from any resulting liability and covenant not to sue in connection with releasing such information. I understand this application will be given active consideration for only 60 calendar days. I have read and I understand the foregoing and accepts its terms and conditions. ___________________________ ______________________________Date Signature of Applicant