ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND

RELEASE LIABILITY AGREEMENT

IN CONSIDERATION OF MY APPLICATION, I, _________________________________, hereby acknowledge and

declare the following:

1. That all the required documents/paper I have submitted relative to my application for
promotion/reclassification have been examined/reviewed by me and are true, correct and complete in
accordance with the guidelines set by the Department of Education;

2. That I am fully aware that I can be held administratively, civilly and/or criminally liable for any
misrepresentation or misstatement appearing in the supporting documents/paper done/certified by me
as correct or authentic in order to deceive or misguide the evaluators;

3. I knowingly and freely assume all such risks, known or should have known to me, accompanying my
submission of the required documents/paper to the Department of Education;

4. I hereby release or hold the Department of Education, its officers, officials and employees free from any
administrative, civil and/or criminal liability arising from my submission of fictitious documents/paper or
the misrepresentation or misstatement I have made or caused to be made on the afore-mentioned
required documents/paper.

I have read this ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND RELEASE LIABILITY AGREEMENT,
fully understanding its terms, and hereby sign it freely and voluntarily without inducement.

______________________________ __________________________
(signature over printed name) Date
Applicant