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In applying for employment, it is understood that we reserve the privilege of contacting past employers regarding references.

The following information concerning citizenship is furnished for the purpose of securing employment with NEONA, and is furnished with full knowledge of Section 911 of Title 18 of the U.S. Code, which provides as follows: “Whosoever falsely and willfully represent himself/herself to be a citizen of the United States shall be fined not more than $1,000.00 or imprisoned not more than 3 years, or both.”

Note: If hired, you will be required to furnish proof of U.S. Citizenship or your authorization to work in the U.S. as specified under applicable U.S. Immigration Laws. If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.

NOTE: This section is not applicable to New Jersey residents.

If yes, give date, court, nature of offense, and disposition.

Please provide professional references - current and past supervisors/managers.

THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND AND AGREE THAT ANY MISREPRESENTATION OR OMISSION OF FACTS IN MY APPLICATION MAY BE JUSTIFICATION FOR REFUSAL TO HIRE, OR TERMINATION OF EMPLOYMENT.

I WARRANT THAT I AM NOT CURRENTLY A PARTY TO ANY EMPLOYMENT OR NON-COMPETE AGREEMENT WHICH MAY LIMIT MY ABILITY TO ACCEPT OR PERFORM THE POSITION FOR WHICH I AM APPLYING.

I FURTHER UNDERSTAND THAT AN INVESTIGATIVE REPORT MAY BE MADE AS TO MY CHARACTER AND GENERAL REPUTATION. I AUTHORIZE ALL PAST EMPLOYERS, SCHOOLS, PERSONS AND ORGANIZATIONS HAVING RELEVANT INFORMATION OR KNOWLEDGE TO PROVIDE IT TO NEONA OR ITS DULY AUTHORIZED REPRESENTATIVE, FOR ITS USE IN DECIDING WHETHER OR NOT TO OFFER ME EMPLOYMENT AND SPECIFICALLY WAIVE ANY REQUIRED WRITTEN NOTIFICATION. I HEREBY RELEASE EMPLOYERS, SCHOOLS, PERSONS AND ORGANIZATIONS FROM ALL LIABILITY IN RESPONDING TO INQUIRIES IN CONNECTION WITH MY APPLICATION.

I AGREE THAT IF I AM EMPLOYED BY NEONA, THE EMPLOYMENT WILL BE EMPLOYMENT AT WILL, AND EITHER I OR NEONA MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME FOR ANY REASON WITHOUT NOTICE, AND THIS APPLICATION SHALL BE A PART OF MY TERMS OF EMPLOYMENT.

IN SIGNING THIS FORM, I CERTIFY THAT I UNDERSTAND ALL OF THE QUESTIONS AND STATEMENTS IN THE APPLICATION.