Please read the sections below carefully before signing.

I certify that the information provided in this application and supporting materials provided by me is true and complete. I

understand the omissions or misrepresentations made on this application or other documentation and / or tests related to

employment will be sufficient cause for cancellation of my application and, if employed, for termination.

My signature on this form is proof that I have authorized the management of the Brunchport, or an agent acting on its

behalf, to collect, use and disclose my personal information as contained on this form for purposes of verifying this

information and assessing my suitability for employment. This consent is valid for the time for the review of my job

application, and, in the event I am hired, for the duration of my employment. I understand that this consent itself may be

provided to other organizations while considering references, as proof that I have consented to the collection of my

personal information for these purposes.

U.S. law requires that, if hired, you must furnish appropriate documentation establishing identity and employment eligibility,

generally within 72 hours of starting work. For example, acceptable documents include: a U.S. Passport, INS forms 688 or

688A; a Social Security Card or birth certificate issued by government authority and a driver's license, school I.D. with

photo or other government issued documentation establishing identity. Certain other documents are equally acceptable.

Please download , fill out and deliver a signed copy of an I-9 form to a member of the management team.

You may exclude information regarding any conviction for which the record has been judicially ordered sealed, expunged

or statutorily eradicated.

By submitting this form, you agree to the following:

I authorize investigation of all statement contained in this application. I understand that misrepresentation or omission of

facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and

may, at the discretion of the employer, be terminated at any time without any previous notice.

I understand that part of the application process includes a written examination and that I may be invited by Brunchport to

attend, at my discretion,training classes which would assist me in preparing for the written examination.

If I am hired by the Brunchport, there will be a three-month probationary work period during which my performance and

suitability for the position will be reviewed;