EMPLOYMENT APPLICATION

APPLICANT INFORMATION

EDUCATION

REFERENCES

CERTIFICATES OR SPECIAL TRAINING

PREVIOUS EMPLOYMENT

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. By my signature below, I expressly authorize Native Environmental and any outside agency retained by Native Environmental to perform and release to Native a background check report and pre-employment drug screening on me in conjunction with my employment application or my job. I understand that if I am employed by Native, my consent will apply throughout my employment to the extent permitted by law unless I revoke or cancel my consent by sending a signed letter or statement to Native. I understand that, to the extent allowed by law, information contained in my job application or otherwise disclosed by me before, during or after my employment, may be utilized for the purpose of obtaining background check reports.