I certify that any and all information submitted in this application form, resume or other information which I provide; and any statements which I make during any interview are true and accurate to the best of my knowledge. Nor will I withhold any information that would affect my application for employment. I understand that there is no obligation to consider or reconsider this application at any time, and that acceptance of this application does not constitute an offer of employment.

I authorize that inquiries may be made with my previous educators, employers, references, consumer credit, private or government agencies and any other individuals who may have knowledge of me or my work experience. I give my consent for any such person or agency to give assessment of my job performance, ability, fitness and/or other information that they may have, personal or otherwise. I agree to cooperate with such an investigation and release all parties from any and all liability, claims or damages, directly or indirectly, resulting from furnishing such information. Upon my written resonable and timely request, a description of the general scope and nature of any such inquiry will be provided to me.

By placing your name in the following box, you acknowledge that you have read and understand everything contained in this document and that all provided answers are true and accurate. *