I authorize you to make such investigation and inquiries of my personal employment, financial or medical history and other
related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will
be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health
care providers and other person from all liability in responding to inquiries and releasing information in connection with my
In the event of employment, I understand that false or misleading information given in my application or interview(s) may
result in discharge. I understand, also, that I am required to abide by all rules implied, stated, spoken and/or written of
Branscome Paving Company.
I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will
be contacted, for the purposes of investigating my safety performance history as required by 49 CR391.23(d) and (e). I
understand that I have the right to:
- review information provided by previous employers;
- have errors in the information correct by previous employers and for those previous employers to resend the corrected
information to the prospective employer; and
- have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree
on the accuracy of the information.
I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or
his agents may investigate my background to ascertain any and all information of concern to my employment history, whether
same is of record or not, and I release employers and other person named herein from all liability of any damages on account of
furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate
that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be
conditioned on the result of physical examination and drug test.
I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of
seeking employment with employer and for no other reason. I agree to furnish such additional information and complete such
examinations as may be required to complete my employment file.
This certifies that this application was completed by me, ad that all entries on it and information in it are true and complete to
the best of my knowledge.