Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
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REFERENCES (do not include relatives)
APPLICATION FOR EMPLOYMENT
APPLICANT STATEMENT: I certify that all of the intomation I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, sithout reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application. I hereby waive any and all rights and claims I may have regarding the employer, its employees, agents, or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other personal, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I further understand that falsification, misrepresentation or omission of facts called for will result in immediate termination from employment or removal of my application from consideration.
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