Please account for ALL periods of employment and any breaks in employment, include self-employment and military service. Begin with your most current employer.

1st Most recent employment

2nd Most recent employment

3rd Most recent employment

Highschool

College

Trade / Vocational School

Please list additional education, training, and/or specialized experience (such as licenses, technical or military experience etc.)

I certify that I have answered all questions truthfully and have not withheld any information. I understand that any falsification, misrepresentation, or omission, as well as any misleading statements, attachments, and supporting documents generally will result in denial of employment or immediate termination, regardless of when and how discovered.

I authorize my current and previous employers (except as noted) to give any and all information regarding my employment. I authorize PML Microbiologicals to request and receive such information and I release PML, any persons, previous supervisors or employers supplying information from any and all liability and from any damage that may result from making the investigation.

If hired, I agree to conform to all rules and policies of PML Microbiologicals. I understand that my employment and compensation can be terminated at any time, with or without cause, and with or without notice, at the option of PML or myself. I understand that the President is the only person who will ever have the authority to create any other terms of employment and/or enter into any employment contract and that all such contracts must be in writing, signed by both parties and the Human Resources Manager. However, I also understand that unless otherwise stated in an employment contract, the company may change, withdraw or interpret other policies (including wages, hours, and working conditions) as it deems appropriate.

I understand that I may be required to submit to pre or post employment or other professional examinations, and/or tests for the presence of drugs. I agree to such examinations and/or testing at PML's expense. Additionally, I hereby authorize the release of results of such examination to PML for use in evaluating my suitability for employment. Further, I release the examining facility and PML from any and all liability arising out of, or connected with any examinations, inquiries, and/or testing.