                 Background Research Release

Please read this section carefully and acknowledge your
understanding by signing your name in the space below.

I certify that all of the statements made by me on this
application for employment are true, correct, and complete
to the best of my knowledge.

1. Consent To Conduct Background Investigation

As a condition of and in consideration for (Company)'s
consideration of this application, I give permission to
(Company) to investigate my personal and employment history.
I understand that this background investigation will
include, but not be limited to, verification of all
information on this application, as well as interviews with
past employers.  I further give permission to (Company) to
conduct this investigation and to discuss the results of
this investigation in connection with my application for
employment.

2. Consent To Contact Past Employers

I give permission to (Company) to contact all employers
listed in this application (except those specifically
excluded) for references.  I further give permission to all
current or previous employers and/or managers or supervisors
to discuss my relevant personal and employment history with
(Company), consent to the release of such information orally
or in writing, and hereby release them from all liability
and agree not to sue them for defamation or other claims
based upon any statements they make to any representative of
(Company).  I further waive all rights I may have under
state law to receive a copy of any written statement
provided by any of my former employers to (Company).  I
further agree to indemnify all past employers for any
liability they may incur because of their reliance upon this
release.

3. Consent To Contact Government Agencies

I give permission to any agent, attorney or representative
of (Company) to receive a copy of any information obtained
in the file of any federal, state or local court,
governmental agency, law enforcement agency or investigator
concerning or relating to me.  I further consent to the
release of such information and waive any right under state
law concerning notification of the request for a release of
such information.  In the event a state law does not provide
for prospective employers to have access to information, I
hereby delegate (Company) as my agent for receipt of
information.  I understand that the scope of this
investigation will be limited to criminal and/or civil
records that relate to my honesty, integrity and/or
abilities.

4. Cooperation With Investigation

I agree to fully cooperate in (Company)'s background
investigation, and to sign any waivers or releases that may
be necessary to obtain access to relevant information.  In
the event that any former employer or federal, state or
local governmental agency will not release reference
information or criminal history information directly to the
employer, I agree to personally request such information to
the extent permitted by law.

[] Note:  Some states prohibit employers from asking
applicants to request their criminal records.  Check with
your state authorities and competent legal counsel prior to
making this request.

5. Falsification Statement

I understand that any falsification or willful omission of
fact made in this application or in connection with any
background investigation may be sufficient grounds for
rejection of this application, or, if discovered after an
offer of employment, for immediate dismissal.

6. Employment "At Will"

In consideration of my employment, I agree to conform to the
rules and regulations of (Company), and my employment and
compensation is "at will" in that they can be terminated
with or without cause, and with or without notice, at any
time, at the option of either (Company) or myself, except as
otherwise provided by law.  I understand that no manager or
representative of (Company), other than the President of
(Company), has authority to enter into any agreement for
employment for any specified period of time or to make any
agreement or contract to the foregoing, and that any
promises to the contrary will only be relied upon by me if
they are in writing and signed by the President of
(Company).

______________________________     ________________
Applicant's Signature              Date


[] Portions of this application are reprinted with
permission from a 1988 special report, Thieves at work:  An
Employer's Guide to Combatting Workplace Dishonesty (BSP
98), published by The Bureau of National Affairs, Inc.

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