I understand and agree that:
1. Employers for whom I have worked in the past may be requested to furnish information concerning my past employment or
activities and I hereby release such employers from liability in connection therewith.
2. Any false statement, omission or misrepresentation made in conjunction with my past record or any other part of my
application for employment will be justification,should I be employed,for my dismissal regardless of when such facts may be
I hereby state that the information I provided is voluntary, factual, and accurate to the best of my knowledge.