I hereby authorize Montgomery Village Foundation, Inc., its agents and representatives, to obtain a full disclosure from my previous employer(s) listed above, or provided separately by me, of any information concerning my previous employment, either oral or written. I indemnify and hold harmless any person to whom this request is presented and its agents and employees from and against all claims, damages, losses and expenses arising out of or by reason of complying with this request. A photocopy or facsimile of this authorization will be valid as an original, even though the photocopy or facsimile does not contain an original writing of my signature. The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application may be considered sufficient cause for dismissal.