The information that I have provided in this Verification of Application is true and accurate to the best of my knowledge. I have answered all questions to the best of my ability, and I have not knowingly withheld information that would negatively affect my application. Any misrepresentations or omissions of fact in this application or any materials submitted with this application may be cause for rejection of this application.

I hereby authorize all my current and former employers who are education providers to disclose the (a) dates of my employment; (b) whether I was the subject of any substantiated reports of child abuse or sexual conduct related to my employment; (c) the dates of any substantiated reports; (d) the definitions of child abuse and sexual conduct used by the education provider when the determination was made that any reports were substantiated; and (e) the definitions of child abuse and sexual conduct used by my education provider employer to determine whether any reports were substantiated.