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Case 18-2868, Document 278, 08/09/2019, 2628230, Page302 of 648 REFERENCES Give BELOW THE NAMES OF THREE PEASCNS NOT AELATED TO YOU, WHOM YOU HAVE XNOWN AT LEAST ONE YEAR NAME ADDRESS o Voor Veulye ; ~, fy ; \ . Lert creas Richa AS AUTHORIZATION cad “I certify that the facts certained in this application are true and complete to the best of my knowledge and urderstand that. if empioyed, fatsified statements on this application shall be grounds for dismissal. ! authorize investigation of al! statements contained herein and the references and employers listed above fo g.ve you any and ail information conceming my previous employment and any pertinent information they may have, personal or otherwise. and release the company from al: liability for any damage that may result from utilization of such information. ! also understand and agree that no representative of the company has any authority to enter into any agreement for ernployment for any specitied period of time, or to make any agreement! contrary to the forego- ing, unless it is in writing and signed by an authorized company representative This waiver does not permit the release or use of disability-related or medical information in a manner pro- hibited by the Americans with Disabilities Act (ADA) and other relevant eral and state laws.” pATE DY Qhka, OQ SIGNATURE _\V LAA pt mts. _ ee Q INTERVIEWED BY ___ DATE _ ee _ DO NOT WRITE BELOW THIS LINE REMARKS } \ BON toy vw = Vib yy Nd ge ob LO VALU OI AA po wena. Gyo | Reoetelly eco cles TENGIWE Feu Or — gxtice i Falere vo osdoum _ T= STEE Sev, on eRe i [NEATNESS [CHARACTER ~] | PERSONALITY — jABILITY ° —_ _ | i i —.--. ——- er — i. — — — niRED "FOR TBOSITION TWILL ]SALARY i DEPT. REPORT WAGES if i APPROVED: 1. _ — 2 _ 3. oe FMPLOYNENT MANAGER, DEPASTMENT HEAD: GENERAL MANAGER PPNCALON tor EMPloyMeNt IE Sold only for genoral ue throughout the United States Auariis assumes no responsibility and rereby disclaims any dapitity for the inclusion i this ny cuastions or reques's for informatan upon wnich a violation of local. siate and/or federal law May be based. it is the user's responsibility to ersure nat this form's use com. 3 wit applicable laws, which change irom time to time.