DECLARATION *

I hereby declare the information provided by me in this application for employment is true, correct and complete. * I hear by authorize the employer, schools, and persons name on this application to give any information requested regarding my employability, character, and qualifications, and release them from all liability for any damages for issuing this information. * I understand and agree that any misrepresentation, false statement, or omissions by me in this application will be sufficient reason for rejecting My application, or for dismissal at any time, during my employment, without liability to my employer and LSCA. * I understand that, consistent with state regulations, I may be required to submit, or provide evidence of, tuberculin testing and or chest x-rays. * I confirm that the information contained on this form is complete and accurate, and that I am not barred or disqualified from working with children, nor subject to any sanctions or conditions imposed by a regulatory body of My employment. * By signing my name below, I understand that nothing contained in this application, or in the interview process is intended to create an employment contract.