STATEMENT OF FACTS
I declare the foregoing to be to the best of my knowledge and belief an accurate statement of facts. It is understood that any false statements or omission of facts will be sufficient reason for dismissal. In making this application for employment it is understood that an investigation may be made whereby information is obtained through personal interviews with your neighbors, friends, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics and mode of living.