Attention: Applicants
I am aware that consumer and motor vehicle reports may be obtained as part of J&W’s evaluation of my job application for employment. These reports may be procured by J&W or its insurance company representative. Personal information from state motor vehicle departments and state agencies including but not limited to driving and criminal records may be obtained. J&W will assess my insurability from its insurance program.
By signing this letter, I hereby provide my authorization for J&W or their insurance company representative to produce such information and reports as well as additional reports about me from time-to-time as deemed appropriate and necessary to evaluate my insurability or for other permissible purposes for employment.
Applicant :
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Personal Information
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Employment Desired
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Education History
Grammar School
High School
College
Trade, Business or Correspondence School
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General Information
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Former Employers
List below last four Employers, starting with last one first
Employer 1
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References
Give below the names of three persons not related to you, whom you’ve known at least one year.
Person 1
Person 2
Person 3
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Authorization
“I 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 they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
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, or to make any agreement contrary to the foregoing, 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.”
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