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MVR AUTHORIZATION

EDUCATION

REFERENCES

EMPLOYMENT HISTORY

MILITARY INFORMATION

ADDENDUM

DISCLOSURE

Consumer reports may be obtained as part of Ten Mile’s, evaluation of my job application/employment. The reports may be procured by Ten Mile. via Penn Dot’s website, and may include my driving record, an assessment of my insurability under the company’s insurance coverage. By signing this disclosure, I hereby authorized Ten Mile to obtain such motor vehicle reports on me from time to time, as it deems appropriate to evaluate my insurability.

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DISCLAIMER

In consideration of my employment, I agree to conform to the rules and regulations of this facility. I understand that my employment can be terminated at any time and for any reason, at the option of either the facility or myself. I understand that no one 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, except for a written employment agreement signed by an administrative representative of this facility. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration of employment and will result in discharge even if discovered at a later date. I also understand any offer of employment is conditioned upon results of post-offer medical examination which includes a drug screening. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any, to provide this facility and all affiliates with any relevant information regarding an employment decision, and I release all such persons from any liability regarding the provision or use of such information. Ten Mile is an equal opportunity employer. No person shall be discriminated against on account of race, color, religious creed, national origin, ancestry, sex, disability or status as a veteran or any other unlawful basis.

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