"I understand that the foregoing is a preliminary questionnaire and that, prior to being considered for employment, I will be required to complete an application.
I certify that the facts contained in this true and complete the best of my knowledge and understand that, if employed, falsified statements on this questionnaire shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."
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