I, certify by entering my name, address and todays date below hereby authorizes Willoughby Roofing & Sheet Metal, Inc. (the "Company") of 111 2nd Avenue NE Cullman, AL 35055 and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. Employment Information: Present or most recent employer/Position: City & State: Dates of Employment: Salary: Reason for Leaving: Former employer/Position: City & State: Dates of Employment: Salary: Reason for Leaving: Former employer/Position: City & State: Dates of Employment: Salary: Reason for Leaving: Tell us more about your job experience: More Job Experience: Education: High School & Location: Did you graduate?.