By submitting this form, I certify that the answers given by me in this application are correct to the best of my knowledge. I understand that any falsification of information on this application, whether willingly or accidentally, is grounds for disqualification of consideration or dismissal from employment if I am hired. I authorize Chocolaterie Stam to contact any and all of the parties listed in this document in order to obtain previous employment information and any other pertinent information. Furthermore, I release Chocolaterie Stam from any and all liability for any damages that may result from the collection of this information. Verification of eligibility to work in the United States must be satisfied for an offer to be made.