ACKNOWLEDGEMENT
By signing this application, I declare that any statement or informaiton provided is true and complete and hereby acknowledge that I have read and understand the following information:
The Bureau has the right to verify information provided in the application. False informaiton may subject an applicant to revocation of this application and/or any other privileges resulting from subsequent placement on the Arbitrator Roster.
In connection with this application, I authorize the Bureau of Mediation Services and any agent acting on its behalf to conduct an inquiry into any information contained in this application pertinent to my potential placement on the BMS Arbitrator Roster. Moreover, I hereby release the Bureau and any agent acting on its behalf from any and all liability of whatsoever nature arising from investigation of this application and the information contained therein.