I acknowledge that the information I have supplied is correct to the best of my knowledge and understand that any deliberate falsifications, misrepresentations or omissions of fact may be grounds for rejection of my application or dismissal from the volunteer program. I understand that consideration for volunteer placement is contingent upon the results of reference, screening for TB and background checks including a criminal check. I therefore authorize this Agency to investigate all statements made on my application and to discuss the results of the investigation with those responsible for volunteer selection and placement. I further authorize the Agency to contact my current and former employers and any listed reference or other persons who can verify information and I give my consent for my employers and other contact persons to respond to questions pertaining to information on this application.