I certify that all information given on this application is true and correct. I also certify that I have accounted for allof my work experience and training on this application. It is my understanding that Toggenburg will make athorough investigation of my entire work and personal history and may verify all data given in my application foremployment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of anyinformation requested and I release from liability any person giving or receiving any such information. Iunderstand that falsification of data so given or other derogatory information discovered will prevent my beinghired, or if hired, will subject me to immediate dismissal. I understand that failure to pass a medical exam, ifrequired, will prevent my employment. I agree to appear upon request for any medical examination required. Ifurther understand that this is an application for employment and that no employment contract is being offered. Iunderstand that if I am employed, such employment is for an indefinite length of time and that Toggenburg canchange wages, benefits, and conditions at any time.
315 683 5842
1135 Toggenburg RoadFabius, NY