Should I be selected to proceed to the background check stage of the hiring process, I grant permission for Zurich North America Insurance Company to secure a Motor Vehicle Record on me. I also affirm the statements made above are stated truthfully and without reservation. By checking the box below, I am providing my electronic signature and acknowledgement of all information provided within this statement.

I certify that the information contained in this application, as well as all documents and submissions in consideration of my hiring, are correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize you to request and receive any and all information concerning my previous employment, education and qualifications for employment. I also authorize any person, organization or company to furnish you with such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself. By checking the box below, I am providing my electronic signature and acknowledgement of all information provided within this statement.✱