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Please list two people we can contact in case of emergency. Please provide any alternate phone numbers, email, addresses, or other means we may use to contact these people.
I certify that the information 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 listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice. I understand that no one is hired as a full time employee, and I fully understand that there is no promise of a set number of hours that I am guaranteed to work per week, and that my hours may fluctuate significantly as they are determined to a great degree on the demands of the business. Finally, I understand that I may be asked to take a drug test prior to receiving treatment for a workman's compensation claim to determine liability for medical coverage and wages.
*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.
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