I acknowledge and declare that I
▪ have provided true and correct representations on this Application Form and not mislead Mariner Marine Insurance in any way;
▪ have not failed to disclose any matter that may have materially influenced Mariner Marine Insurance decision to employ me;
▪ have disclosed all criminal convictions or charges not covered by the Clean Slate Act, whether I consider such convictions or charges to be relevant to this application or not;
▪ for the purposes of the Privacy Act, consent to Mariner Marine Insurance contacting any of my past employers and referees for reference checking;
▪ have not failed to disclose any medical conditions or injuries that may affect my ability to perform the job adequately and/or safely; and
▪ understand that if I am successful in securing a position with Mariner Marine Insurance and Mariner Marine Insurance later discovers that I have mislead them in any way; including but not limited to a failure to disclose criminal convictions or charges (whether I consider them relevant or not) that a breach of trust and confidence has occurred and Mariner Marine Insurance may take disciplinary action up to and including summary dismissal (termination of my employment without notice).