I certify that the information given by me in this application is correct and without consequential omissions and understand that any mis-statement and omission will void this application and is grounds for dismissal in accordance with New Orange Hills Policies. I authorize any company, school, or other institution, or person to release any information regarding my employment, character, qualifications of health and release all parties from all liability for any damage that may result from furnishing the information given. In consideration of my employment, I agree to conform to the rules and regulations of New Orange Hills. I further understand that no manager, representative of New Orange Hills, other than the Administrator, has any authority to enter into any agreement for any specified period of time, or make any agreement contrary to the foregoing. I understand that in order to be selected for employment, I must agree to submit to a pre-employment physical exam and test. These shall include, but are not limited to, a physical exam, x-ray, tuberculosis skin test, urinalysis, and blood test to determine the presence of contagious diseases, chemical dependency, etc. I further understand that the results of the exam and tests shal be submitted to the employer for evaluation and must satisfy the standards set by the employer before I can be considered for employment.