I certify the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed by Life Force of Western PA, any falsified statements on this application shall be grounds for dismissal.
I authorize Life Force of Western PA to investigate all statements contained herein and the references and employers listed above to give Life Force of Western PA any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Life Force of Western PA from any liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of Life Force of Western PA has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement
contrary to the foregoing, unless it is in writing and signed by an authorized company representative of
Life Force of Western PA.
I also understand that I may be required to fill out a paper application for my records should I be employed by Life Force of Western PA.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.