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I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application of dismissal from subsequent employment.

I authorize any representative of Producers Cooperative Marketing Association bearing this release to obtain any and all information from the references listed in this application relating to my activities or employment, including information that may otherwise be considered confidential. This information may include, but is not limited to, the circumstances under which I left my previous employment, my achievement, performance, experience, attendance, character, personal history, and disciplinary records. By means of this authorization, I direct the references listed in this employment application to release such information upon request by a representative of Producers Cooperative Marketing Association. I understand that the information released is for official use by the Producers Cooperative Marketing Association and may be disclosed to such third parties as necessary, in the fulfillment of official responsibilities.

I hereby release the references listed in this application, including their employers and any representatives of the reference or employer, from any liability for damages that may result to me on account of compliance, or any attempts to comply, with this authorization, including, but not limited to liability for demotion, libel, slander, or negligence.

I authorize the references listed on the previous to give you any and all information, including settlement agreements, non renewals, or termination, concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damages that may result from furnishing the same to you.