This certifies that I personally completed this application, and that all entries and information that I have provided are true and complete to the best of my knowledge. I authorize A.L. Boeck & Co. to make such investigations of my personal, employment, financial or medical history and other related matters, as may be necessary in order to make an employment decision. I understand that employment is considered upon verification of the information contained herein.

I authorize the listed employers, schools, and personal references, as well as any other persons, schools, companies, credit bureaus, state licensing enforcement and other government agencies, to give A.L. Boeck & Co. (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have, personal or otherwise. I release all parties from all liability, and agree not to file any claim, lawsuit or any other cause of action of any kind against any person or entity arising out of the furnishing or use of such information.

In the event of my employment by A.L. Boeck & Co., I understand that false or misleading information given in my application or interviews may result in termination of my employment. I also understand that, if hired, I am required to abide by the policies and practices established by A.L. Boeck & Co. I further agree that I have the right to terminate my employment without notice at any time for any reason, and that A.L. Boeck and Company also retains this right.