PLEASE READ CAREFULLY BEFORE SIGNING THIS FORM

I authorize investigation of the reference listed above to give The Arc of Fond du Lac, INC. any and all information concerning my current/previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

Upon a job offer from The Arc of Fond du lac, INC. and at any time during my employment I authorize The Arc of Fond du lac, INC. to obtain an investigative consumer reports that may include but not limited to a criminal records checks and driving records. The Arc of Fond du Lac, INC. further requires pre-employment drug screening.

* I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that misrepresentation or omission of facts in this application may result in my discharge. If employed, I understand and agree that such employment may be terminated at any time, without prior notice, and that my employment will not be governed by an expressed or implied contact but is at-will. I hereby give the employer the right to investigate all references unless otherwise stated herein.