I certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements or omissions will be considered cause for dismissal. Dumbaugh Insurance Agency, Inc is hereby authorized to conduct any verification of my personal, employment, education, credit and motor vehicle records, and to receive any information from the criminal justice agency in any state. I authorize listed previous employers and submitted references to give Dumbaugh Insurance Agency, Inc or its designated agent any and all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise. I release all such parties from any liability that may allegedly arise from furnishing such information to Dumbaugh Insurance Agency, Inc including, but not limited to, any liability for defamation or invasion of privacy.
If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation. If my application is accepted for employment, I understand that the first ninety (90) days is an introductory period and I understand that my employment and compensation can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my probationary period, at the option of either Dumbaugh Insurance Agency, Inc or myself. I understand that no leader or other representative of Dumbaugh Insurance Agency, Inc other than the president of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I certify that I have read, understand and agree with the above.
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122 S Main StMount Vernon, OH 43050740-397-1234
66 N Chestnut StFredericktown, OH 43019740-694-1234
13 E Winter StDelaware OH 43015740-369-0123