Applicant's Certification

Please read carefully before signing.  If you have any questions regarding the following statements, please ask for assistance.

I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete.  I understand that any false information contained in this application may result in my discharge.

I authorize you to communicate with all my former employers, school officials and persons named as references.  I hereby release all employers, schools and individuals from any liability for any damage whatsoever resulting from giving such information.

I understand that as this organization deems necessary, I may be required to work overtime hours or hours outside a normally defined work day or work week.   If employed, I understand and agree that such employment may be terminated at any time and without any liability to me for any continuation of salary, wages, or employment.

Signature of Applicant_______________________________

Date ___/___/___