Nielsen's House of Learning

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Agreement and Consent Form
First Name
Last Name
E-mail Address
Date
Please read the following statements carefully and indicate your understanding and acceptance by responding in the affirmative in the space provided. I certify that all the information in this application is true and correct, and I further understand that any misstatement or omission of information may be grounds for disqualification or immediate dismissal. Initials:
I authorize all persons listed to give Nielsen's House of Learning any and all information regarding my previous employment and education and any other pertinent information they may have, personal or otherwise, and release all parties, such persons, and the Company from liability for any damage that may result from furnishing same to the Company. Initials:
I certify that all the information contained in this application (and any accompanying information that I may submit) is true and correct, and further understand that any misstatement or omission of information is grounds for rejection of employment, or if employed, termination from Nielsen's House of Learning. In addition, I authorize Nielsen's House of Learning to obtain copies of any information pertaining to any criminal history maintained by any law enforcement agency and to use said information for the purpose of evaluation of my application for employment. Any falsification of this record will be sufficient cause for disqualification. Furthermore, it is understood that this application becomes the property of Nielsen's House of Learning which reserves the right to accept or reject it. References and personal information which becomes a part of this record are to be regarded as confidential and shall not be revealed to me. Initials:
If employed by Nielsen's House of Learning, I understand that I must conform to the rules and regulations of Nielsen's House of Learning. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of either Nielsen's House of Learning or myself. I further understand that no representative of Nielsen's House of Learning, other than the owner/director, has any authority to enter into any agreement, oral or written, for employment for any specified period of time or to make any assurance or promise of continued employment. Initials:
This application becomes a public record and is subject to disclosure.
Type "YES" if you agree to the above
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