Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.

I authorize you to verify the information listed above. I certify that the information contained in this employment application is accurate and truthful. I understand that providing false information on this application may be grounds for not offering me employment or for the termination of my employment at any point in the future.