I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Vivalon to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the agency any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the agency, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the agency. In addition, I understand and agree that if I am employed, my employment is (At-will) for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the agency, and that no promises or representations contrary to the foregoing are binding on the agency unless made in writing and signed by me and the agency’s designated representative.

Upon employment, you will be required to submit to a finger print criminal record background check and may be required again in three years. Conviction of certain sexual felonies will disqualify you for continued employment with Vivalon.

If I am applying for a job that involve driving my own vehicle or a company vehicle on behalf of Vivalon, I herby authorize Vivalon’s insurance company and/ or Heffernan Insurance Brokers to be in possession of my drivers license number, obtain the necessary motor vehicle records and authorize them to send a copy of my Motor Vehicle Record to Vivalon.