READ THE FOLLOWING STATEMENT AND SIGN BELOW
I have not been and am not now a member of any organization which advocates the forceful overthrow of the U.S. Government.
I also state that I am a legal citizen of the United States of America.
If not a legal citizen, I hereby state that I am in the United States of America legally and if hired
will supply PJ&S copies of papers showing that I am legally in the United States of America. I also agree that, if hired, I will
notify PJ&S immediately when this legal status changes.
I authorize you to make such investigations and inquiries of my personal, employment, financial or
medical history and other related matters as may be necessary in arriving at an employment decision.
I hereby authorize Employers, Schools, Doctors, Hospitals or Persons to give any information regarding
me in responding to inquiries in connection with my application. Upon my written request, within a reasonable time, additional disclosure
concerning the nature and scope of the information requested will be provided.
I understand that misrepresentation or omission of the facts called for herein will be sufficient cause for
cancellation of the application and/or for termination from the Company's service if I have been employed. I also understand that
employment is subject to a satisfactory physical examination, including taking a drug test if requested, by a physician if PJ&S deems necessary.
I hereby acknowledge that any action, damage and liability caused by the misrepresentation or omission of
any requested information on this application will be the applicant's responsibility. PJ&S will be reimbursed by the applicant for any cost
due to misrepresentation of the facts by the applicant.
***PLEASE NOTE THAT ENTIRE APPLICATION MUST BE FILLED OUT FOR CONSIDERATION -
IF “NO” ANSWER APPLIES, PUT N/A IN BLANK. LEAVE NO BLANK SPACES. ***