In your own handwriting, copy the following paragraph in the space provided. Then sign the form in the appropriate place, having your signature witnessed by a NOTARY PUBLIC OR COMMISSIONER OF DEEDS. Your signature affixed in the indicated location is an endorsement of your agreement with the contents of your handwritten paragraph.

"I hereby acknowledge that I have read the instructions contained in the foregoing application, and have completed the application in accordance with the instructions. I affirm that I have completed the application fully, truthfully, and to the best of my knowledge. I am aware that any deception or any attempt to deceive by me in the completion of this application, or in the subsequent character investigation to be conducted by the Oakwood Public Safety Department, may result in a rejection of my application from consideration for the position of Public Safety Officer."

I, , being duly sworn, depose and say, that I am the person whom the foregoing application concerns; that I completed the application in my own hand; and that the answers I have given to each and every question therein are full, complete, true, and correct, to the best of my knowledge.

NOTICE: FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A FIRST DEGREE MISDEMEANOR PURSUANT TO SECTION 2921.13(A) (8) OF THE STATE OF OHIO REVISED CRIMINAL CODE.