I attest, under penalty or perjury, that I am a citizen of the United States. I certify that I have ready
carefully read this form and the information contained herein is correct to the best of my knowledge. I
understand that any false information is grounds for dismissal. I understand that part of the procedure
for my employment application an investigative consumer report may be made to verify. I acknowledge that
if hired, I am subject to random drug screening.