I hereby certify that the answers given by me to the questions and statements on this application are true and correct. I agree to submit to a physical examination, if requested, and I understand that my membership will be contingent on the results thereof. I also authorize my former employers to give any information they may have regarding me. I hereby release them and their company from all liability for any damage whatsoever for issuing same. If upon investigation, anything contained in this application is found to be untrue, I understand that I will be subject to dismissal at anytime during the period of my membership.