I hereby certify under penalty of A.R.S. §13-2704, that the entries on this statement and attached continuation sheet(s) are true, complete, and correct to the best of my knowledge and belief. These entries are made in good faith. I understand that a false or misleading statement on this form constitutes a violation of the law, Pima County, and the PCAO Policies and Procedures and is caused to deny my employment with the Pima County Attorney for dismissal if known after employment.

in order to be considered for a position with the Pima County Attorney's Office, hereby authorize PCAO to perform a full background check including a computerized criminal history check, reference checks, and employment verifications. These checks may include, but are not limited to, discussions with supervisors, co-workers, business associates, or other individuals that PCAO, in its sole discretion, believes may have relevant job-related information regarding my suitability for employment. PCAO may also verify the information I have provided on my employment application and/or resume.

I agree not to assert any demands, damages, claims, suits or causes of action of any kind against PCAO, its officers, employees, agents, or the organizations, offices, employees, and agents contacted arising out of PCAO performing a good faith effort to check my employment references and criminal history. I acknowledge that my failure to authorize PCAO to check my references shall disqualify me from consideration for employment. I also acknowledge that PCAO has made no representations that employment will be offered to me upon the completion of reference checks. A photocopy or facsimile (“fax”) of this form show my signature and shall be as valid as the original.