Disclaimer & Signature
I hereby authorize investigation of all statements in this record. I certify that such statements are true and understand that misrepresenting or omission of facts called in this form is cause for separation from the company's service. I also agree (1) to such physical examination by a company-designated physician as may be required; (2) if employed, to abide by rules of absence, layoffs, transfers, termination, health services, and general conduct; (3) if employed, I agree that at any time during my employment, or at the termination thereof, my employer or his authorized agent shall desire to search my person, trunk, clothing, locker and effects - I will submit to such examination, without objection, and hereby waive and release all claims for damages on account of such examination of my detention for that purpose.
The Civil Rights Act of 1964 prohibits discrimination in employment practice of race. color, religion, gender, or nation origin.