**PLEASE READ THE FOLLOWING STATEMENTS.
BY COMPLETING THIS FORM I AM AGREEING TO THE FOLLOWING STATEMENTS BELOW.
"The facts set forth in my application are true and complete. I authorize the investigation of all statements contained in this application and hereby authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from all liability on account of furnishing such information. I understand that false statement, omission or misleading statements on this application shall be considered sufficient cause for refusal to hire or dismissal and that
I agree that my employer shall not be held liable in any respect if my employment is terminated because of such omissions or false or misleading statements.
Total Employee Leasing and New Horizons of Northwest FL, Inc. are hereby authorized to investigate my employment history, including the contacting of any employers listed."