Disclaimer and Signature
I hereby certify that the information provided herein is correct to the best of my knowledge and
understand that falsification of this information is grounds for refusal to hire or, if hired,
dismissal.
I hereby authorize any of the persons or organizations listed in this form to give all information
concerning my previous employment, education, or any other information they might have, personal or
otherwise, with regard to any of the subjects covered by this form, and release all such parties,
agencies and entities from all liability that may result from furnishing such information to you. I
authorize you to request and receive such information.
In consideration for my employment and my being considered for employment by Avi-Con, Inc., I agree
to adhere to the rules and regulations of the company and hereby acknowledge that these rules and
regulations may be changed by your company at any time, at the company's sole option and without any
prior notice. In addition, I understand and agree that employment with Avi-Con, Inc. will be "at
will" and acknowledge that my employment may be terminated, and any offer of employment, if such
is made, may be withdrawn, with or without prior notice, at any time, at the option of either the company
or myself.
I consent to a drug test, either prior to commencement of employment or after I have become employed,
as deemed necessary by the employer.