The information in this application is correct and complete to the best of my knowledge
and I assume responsibility for all statements on this form. I understand that if I am found
after hearing to have knowingly or negligently made a false statement on this or any
other document submitted to the Department, I may be subject to fine, imprisonment,
and/or barred from filing further documents with the Department. I also understand it is
unlawful to give to a city employee, or for a city employee to accept, any benefit,
monetary or otherwise, either as a gratuity for properly performing the job or in
exchange for special consideration.