IN MAKING THIS APPLICATION FOR EMPLOYMENT AN INVESTIGATIVE CONSUMER REPORT MAY BE PREPARED WHEREBY INFORMATION IS OBTAINED THROUGH PERSONAL INTERVIEWS WITH YOUR NEIGHBORS, FRIENDS, OR OTHER ACQUAINTANCES. SUCH AN INQUIRY WOULD INCLUDE INFORMATION AS TO CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS AND MODE OF LIVING. YOU HAVE THE RIGHT TO MAKE A WRITTEN REQUEST WITHIN A REASONABLE PERIOD OF TIME TO RECEIVE ADDITIONAL DETAILED INFORMATION ABOUT THE NATURE AND SCOPE OF THIS INVESTIGATION. I AUTHORIZE YOU TO COMMUNICATE WITH PERSONS LISTED AS REFERENCES, FORMER EMPLOYERS, AND ANY OTHERS WITH WHOM YOU DESIRE TO CHECK. I AGREE TO HOLD SUCH PERSONS HARMLESS WITH RESPECT TO ANY INFORMATION THEY MAY GIVE ABOUT ME. IF EMPLOYED, I AGREE TO ENGAGE IN NO OUTSIDE ACTIVITY WHICH WOULD INVOLVE A MATERIAL CONFLICT OF INTEREST WITH, OR WHICH COULD REFLECT ADVERSELEY ON THE COMPANY. I UNDERSTAND THIS DECISION IS TO REST WITH THE COMPANY. IF EMPLOYED, I AGREE TO HOLD IN STRICTEST CONFIDENCE ANY INFORMATION CONCERNING THE COMPANY, ITS INSUREDS, AND ITS AGENTS WHICH MAY COME TO MY KNOWLEDGE. IN CONSIDERATION OF MY EMPOYMENT, IF I AM EMPLOYED, I AGREE TO CONFORM TO THE EMPLOYMENT POLICIES OF THE COMPANY, AND I UNDERSTAND THAT NO REPRESENTATIVE OF THE COMPANY, OTHER THAN THE PRESIDENT, HAS THE AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING. I UNDERSTAND THAT COMPLETION OF THIS APPLICATION FOR EMPLOYMENT DOES NOT GUARANTEE THAT I HAVE BEEN EMPLOYED BY THIS COMPANY. I HEREBY AFFIRM THAT MY ANSWERS TO THESE STATEMENTS AND QUESTIONS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I HAVE NOT KNOWINGLY WITHHELD ANY FACT OR CIRCUMSTANCE THAT WOULD, IF DISCLOSED, AFFECT MY APPLICATION UNFAVORABLY. I UNDERSTAND THAT ANY MISREPRESENTATION, DECEPTION, OR FALSE STATEMENT MADE IN THIS EMPLOYMENT APPLICATION MAY RESULT IN MY NOT BEING CONSIDERED FOR EMPLOYMENT, AND IF NOT DISCOVERED BY THE COMPANY UNTIL AFTER BECOMING EMPLOYED, IS GROUNDS FOR, AND MAY RESULT IN, MY IMMEDIATE TERMINATION. I UNDERSTAND THAT THE COMPANY MAY REQUIRE THE SUCCESSFUL COMPLETION OF A URINALYSIS FOR DRUG TESTING PURPOSES AND/OR A BLOOD ALCOHOL TEST AS A CONDITION OF EMPLOYMENT. BY SUBMITTING THIS APPLICATION FOR EMPLOYMENT, I HEREBY CONSENT TO EITHER OR BOTH OF SAID TESTS, AT THE COMPANY’S DISCRETION. DATE SIGNATURE OF APPLICANT I UNDERSTAND THAT MY APPLICATION WILL REMAIN ACTIVE FOR 30 DAYS FROM THE DATE RECEIVED