By State policy, we are required to verify your employment with all former employers. Please thoroughly read and complete the attached Employment Application Supplement. Failure to comply could affect your status in the position selection process.
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed to give you all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and the release of all parties from all liability for any damage that may result from furnishing same to you. Per State policy, I acknowledge that I have received for my information a copy of the DDS 59 (Rights and Responsibilties of Community Service Worker in an Investigation of Maltreatment). I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.
(Typed name will serve as electronic signature)