TO BE READ AND SIGNED BY THE APPLICANT    

~ This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Any misrepresentation of information given above shall be considered an act of dishonesty and can result in my immediate dismissal or rejection.

~ I agree to voluntarily submit to a pre-employment physical, drug screen and driver evaluation should I meet the qualifications of the position for which I have applied and agree to produce documentation to verify my identity and legal authorization to work in the U.S. as required by the Immigration Reform & Control Act of 1986. I agree to furnish such additional information and complete such examinations as may be to complete the employment file on the contingent of a job offer. It is agreed and understood that this application is not a contract for employment and in no way obligates the employer to employ the applicant.

~ If hired, I agree to abide by all the rules and policies of the employer. It is also agreed and understood that under the Fair Credit Reporting Act, this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

~ By my signature below, I hereby authorize all companies that I have worked for or applied for employment with (even if not hired) to release all information concerning my employment. I hereby release you from any and all liability of any type as a result of providing information to Witte Bros. Exchange, Inc. I also authorize all companies in the past 3 years from the date of this authorization to release information concerning my drug and/or alcohol test(s) as conducted under 49 CFR Parts 382, 391 and 392 to Witte Bros. Exchange, Inc.