I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsification or significant omission of information requested in this application or in the application process may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize all persons listed above (and on the accompanying resume, if any) to give employer and/or any service providers any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and employer and/or any service providers, from liability for any damage that may result from furnishing same to employer and/or any service providers.