If yes, provide dates of employment, location and reason for separation from employment.
If you answered Yes to any of the above three questions, please explain the circumstances of each occasion.
If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicants parent or legal guardian constitutes acknowledgment by the applicant and the parent or guardian that the Company, to the extent permitted by federal, state, and local law can test the applicant for illegal or controlled substances, conduct inspections of property without notice and communicate test results to Company personnel who need to know, the applicant, and the applicant's legal guardian.