List three (3) persons, NOT RELATED TO YOU, whom you have known at least one year.

1. Name
   Address
   Phone
   Occupation
2. Name
   Address
   Phone
   Occupation
3. Name
   Address
   Phone
   Occupation

As a job applicant, I freely and voluntarily agree to a urinalysis drug screen as part of my application for employment and I understand that a refusal to test, a positive confirmed drug test or a tampered with or an adulterated specimen will disqualify me from employment, even if I have started work pending the results of the drug test. I understand I am still completing the application process and will not officially be an employee until the company receives a negative pre-employment drug test result. If I am employed by this company, I understand and agree to abide by this company’s Drug Free Workplace policy, under applicable State law.

I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with R4 Restoration creates an actual or implied contract of employment. I understand that if I accept employment with R4 Restoration it will be on an at-will basis. This means that either R4 Restoration or I have the right to terminate the employment relationship at any time, for any reason, with or without cause. I agree to submit to drug and alcohol testing, if requested by R4 Restoration I release R4 Restoration, and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing. I authorize R4 Restoration to investigate information concerning my education, credit history, employment experiences and all other aspects of my background relevant to my proposed employment. I release R4 Restoration and its employees from all liability arising from such investigation.