|EMPIRE EMPLOYMENT APPLICATION|
|Empire is an Equal Opportunity Employer dedicated to non-discrimination in employment.|
|List below all present and past employment starting with your most recent (or current) employer. Account for all periods of unemployment. If attaching a resume please complete information not contained in the resume.|
| I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, their agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.|
|DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.|
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.