Declaration: By signing this document I hereby declare that the details furnished above are true and correct to the best of my knowledge
and belief and I undertake to inform you of any changes therein, immediately.
In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that it will result in termination of employment at any time (if hired) and I may be subject to applicable penalties under New York State laws.
I understand that filling this questionnaire does not constitute an offer for employment but merely an opportunity to provide additional information to compete for the position. I have provided this information willfully and without assistance from any other person.