VII. CERTIFICATION OF APPLICANT AND RELEASE OF EMPLOYMENT INFORMATION
Please Read Carefully Before Signing
A. I hereby certify that the information contained in this application is true, correct, and
complete. I agree and understand that any false or misleading statements or omissions made in
this application or interview(s) are grounds for disqualification from further consideration or for
dismissal from employment, regardless of when and how discovered. Additionally, information
that cannot be officially verified may be a basis for not hiring me for employment with the
University of Hawaii.
B. I understand that failure to provide requested application information on a timely basis may
deem my application to be incomplete.
C. I understand that, if selected, I must present documentary evidence to verify my employment
eligibility, pursuant to the Immigration Reform and Control Act of 1986.
D. I understand and agree that the University of Hawai‘i may make a full and complete
investigation of my personal or employment history, and authorize any current or former
employer, person, firm, corporation, school, government agency, or other entity to provide the
University of Hawai‘i with any information (including fact or opinion) they may have regarding
me. In consideration of the University of Hawaii’s review of this application, I release the
University of Hawai‘i and all providers of any information from any liability which may arise as
a result of furnishing and receiving this information. I understand and agree that any
employment offer or continued employment shall be conditional on the receipt of satisfactory
references as determined by the University of Hawai‘i. If employed by the University of
Hawai‘i, I further authorize the University of Hawai‘i to provide truthful information (including
fact or opinion) regarding my employment to any potential or future employer.
E. I agree that the University of Hawai‘i as permitted by state law, may inquire into and
consider any criminal conviction record that I may have. This includes, but is not limited to, the
University of Hawai‘i considering any criminal conviction record that I may have after it makes
a conditional offer of employment. The University may withdraw a conditional employment
offer if I have a criminal conviction record which bears a rational relationship to the duties and
responsibilities of the position for which I am applying. Any criminal conviction record that is
more than 10 years old (excluding periods of incarceration) or that involves certain Family Court
matters will not be considered, except as permitted by law.
F. If hired, I agree not to disclose or use confidential information belonging to prior employers
and that I will inform the University of Hawai‘i of any agreements that would limit my ability to
work for the University of Hawai‘i.
Photocopies of this authorization for the release of information shall have the same power and
effect as an original.
AUTHORIZATION SIGNATURE OF APPLICANT:__________________________________
An Equal Opportunity/Affirmative Action Institution
CC Personnel Form 27A (Revised 01/2012)