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I certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give American Vacuum any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company 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, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I hereby declare that I am not disabled in any way which would prevent me from steadily performing all the work applied for in this application. I authorize the company to contact any of my previous employers as well as any reference source I have provided in order to verify the facts and information I have furnished regarding my qualifications and character. I hereby authorize any person(s) having knowledge thereof to provide such information to the company, and I hereby release from liability and agree to hold harmless any person that furnishes such information in good faith. I agree that I will submit to a physical, urinalysis, and/or blood or other examination requested by the company at any time prior to or subsequent to my employment. I authorize the company to supply my employment record in whole or part and in confidence to any employer, insurance agency, or other party with a legal and proper interest, and I hereby release the company from any liability and agree to hold harmless any employee of the company who furnishes such information. I further understand that my employment is for no fixed time and may be discontinued with or without cause. I understand that no employee or officer agent of the company may bind this information by oral or printed statements, including handbooks, benefit books, or bulletins, contrary to the above. I have carefully read the information on this form; I realize I had the opportunity to ask questions and I accept that the information I have signed for is understood. By placing my signature below, I certify that the information I have provided on these pages is complete and true to the best of my knowledge. The falsification of data or omissions of material facts will constitute grounds for dismissal and denial of application.