Please read the instructions carefully before answering questions regarding criminal history. For these instructions, the words “convicted” and “conviction” include guilty pleas and pleas of “no contest”. If you question whether your conviction is excluded, consult your own attorney. You are responsible for accurately responding to questions about your criminal history. The instruction applies to both adult and juvenile records, and both felony and misdemeanor convictions.
Time Limits: You are not required to disclose and felony conviction that is more than 10 years old. If you have been convicted of another offence within that last 5 years, you must disclose all convictions that occurred within the last 10 years. For purposes of the instruction, if you were incarcerated as a result of your conviction, use the last date of incarceration rather tha the date of conviction in calculating the 5 year or 10 year period.
Misdemeanor Convictions: You are not required to disclose misdemeanor convictions except for those crimes involving dishonesty or theft (e.g. fraud, forgery, shoplifting, larceny, embezzlement).
Juvenile convictions: You are not required to disclose juvenile records, unless it applies to the above instructions.
I certify that the facts contained in this application are true and complete to the best of my knowledge and
understand that, if employed; falsified statements on this application shall be grounds for dismissal. I
authorize investigation of all statements contained herein and the reference and employers listed, to give
you and all information concerning my previous employment and any pertinent information they may have,
personal or otherwise, and release the company from all liability for and damage that may result from the
utilization of such information. I also understand and agree that no representative of the company 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 written and signed by an authorized company representative.
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