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Disclaimer & Signature ​
Read carefully and sign below
I certify that the facts set forth in this Employment Application, in my résumé, and in the other
materials I have submitted are true and complete. I understand and acknowledge that false
information provided by me will result in disqualification from employment or in dismissal from
employment if an offer of employment has been made and accepted. I understand that my
employment will be contingent, if selected, on my completion of the pre-employment process which
may include a background check and drug screen. I authorize the company to perform a drug screen
and will sign all authorizations related to complete a criminal background check and/or credit check if I
am conditionally offered a position of employment.
I hereby authorize the Company to contact all my former and current employers, educational
institutions, military entities, and the other references I have provided regarding me and my
performance record and work, academic, and/or military experience. I hereby authorize my current
and former employers, educational institutions, military entities, and the other references I have
provided to disclose to the Company all information regarding me.
I also hereby release the Company and its employees and agents, and all of my former and current
employers, educational institutions, military entities, and the other references I have provided from any
and all liability and damages for releasing or using information concerning me and my performance
record and work, academic, and/or military experience. I also hereby waive any right under the
Bullard-Plawecki Right to Know Act, 1978 PA 397, to receive written notice from the Company or any
former or current employer that disciplinary reports, letters of reprimand, or other disciplinary action
taken against me while employed will be or have been disclosed to a third person or entity.
I understand that the Company may conduct a conviction-only criminal background history search on
me consistent with applicable law. I hereby consent to this search being conducted and to the
disclosure of the results of that search. I hereby release the individual or entity conducting the search,
the Company, and its employees and agents, from any and all liability, claims, and damages, including
but not limited to, claims for releasing or using any information revealed as a result of this search. I
also understand and acknowledge that criminal convictions can result in disqualification from
employment with the Company or in my dismissal from employment if an offer of employment has been
made and accepted. I understand that all criminal convictions will be individually assessed to determine
whether they will disqualify me from employment.
In consideration of my employment I agree and understand that my employment, compensation, and
benefits can be terminated with or without notice, and with or without cause, at either my option or at
the option of the Company, it being mutually understood and agreed that my relationship with
Company is one of employment at-will. No representatives of the Company, other than the President,
has any authority to enter into any agreement for employment for any period of time or to make any
agreement contrary to the foregoing, and any such agreement must be in writing and signed by the President.
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I further recognize that if employed by the Company, I agree, in consideration of my employment, to
file any claim or lawsuit arising out of or in any way related to my employment and/or cessation of my
employment within one hundred eighty (180) days after the claim(s) arise(s) or within the applicable
statutory limitations period(s) provided by law, whichever expires first, and my failure to do so shall act
as a bar to any claim that I may have.
If I am employed by the Company, I understand that additional personal data will be required for
statistical purposes. I will abide by all policies, rules, and regulations of the Company.
I understand that if I have a disability as defined under the Michigan Persons with Disabilities Act, I
must timely inform the Company in writing of my need for an accommodation within one hundred
eighty-two (182) days after I know or reasonably should know that an accommodation is needed. I
further understand failure to do so will prevent me from alleging a violation of the accommodation
requirements otherwise imposed by applicable law.
I understand that it is the policy of the Company to maintain a work place free from the effects of both
illegal drugs and/or alcohol. I understand and agree I may be tested for illegal drug and alcohol use
during my employment as the Company deems necessary in its sole discretion. My refusal to take a
test, altering the results of a test, tampering with my sample, or failing the test will disqualify me from
employment. I understand a drug test may be required prior to employment and at any time during my
employment at the sole discretion of the Company. I understand that my possession of a valid medical
marijuana shall be no defense of a positive drug test. I agree, if employed, to submit to a job related
medical exam at any time at the Company’s request. I consent to have the results of any post offer,
pre-employment, or post employment medical examination I am required to undergo disclosed to the
Company. I also acknowledge that if hired I may be required to submit to medical/physical
examinations which are job related and consistent with business necessity.
I shall promptly report all work-related injuries and/or illnesses to the Company as soon as possible
following any incident. I understand that all processing of such claims will be done by the Company’s
workers’ compensation insurance carrier.
I have read each paragraph above and accept the terms and conditions described.
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The Company does not discriminate on the basis of race, national origin, color, sex, age,
religion, weight, height, marital status, veteran status, disability or non-job related
medical conditions, or any other protected category in accordance with state, federal, or
local laws.
Once my application file is complete, the Company will keep this application for at least
one (1) year or any other period of time dictated by the state or federal law. I understand
that any application I submit will be active for sixty (60) days only and will be considered
only for the position I originally applied for. I will have to reapply for any new job
openings. All materials submitted become the property of the Company.
I certify that my answers are true and complete. If this application leads to employment, I
understand that false or misleading information in my application or interview may result in
my release upon discovery of same.