Certification and Acknowledgement
I certify that the information provided herein is true and correct to the best of my knowledge. I understand
that, if employed, falsified statements on this Application for Employment form will be considered grounds for
I understand that I may be required to supply my birth certificate or other proof of authorization to work in
the United States, consent to a drug test, and/or sign a conflict of interest agreement and abide by its terms.
I authorize the company to thoroughly investigate my work experience and any other matters related to my
suitability for employment. I further authorize my former employers to disclose to the company any and all
information they may have concerning my previous employment. In addition, I hereby release Harper Special
Services, my former employers, and all other persons from any and all claims, demands, or liabilities arising out of,
or in any way related to such disclosure.
I acknowledge that, if employed, both Harper Special Services and I have the right to terminate the
employment relationship at any time, with or without cause or advance notice. This employment at will relationship
will remain in effect throughout my employment with Harper Special Services and may not be modified by any oral implied agreement.