I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize LaCasita Staffing to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of LaCasita Staffing, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.

(Please read and sign this form in the space provided below. Your written authorization is necessary for completion of the application process.) I hereby authorize LaCasita Staffing LLC to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that LaCasita Staffing LLC will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.

Under the Fair Credit Reporting Act, this form, or one functionally similar to it, must be signed by an applicant before a prospective new employer may perform a background check on the applicant using an outside, for-profit firm, including search engines on the Internet. No such requirement applies if the background check will be performed solely by the company using databases maintained by government agencies.