How Long Have You Been at Your Current Address?
Do you have any illness, injury, physical or mental conditions which might interfere with performing certain kinds of work?
The facts set forth above in my application for employment are true and complete. I understand that false statements, misrepresentations or omission of facts will disqualify my application, or if hired will be cause for dismissal. You are hereby authorized to investigate all statements contained in this application. I further understand that employment will not be for a fixed term and will depend on work performance of a continuing high standard, and upon the continuing need and desire for my services.