December 20, 2021

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1Undertaking

2Personal Data

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I hereby affirm that the statements made by me in this application are true and correct; that I have accounted for all of my employed time and that I have not knowingly withheld any fact or circumstance which would, if disclosed, affect my application unfavorably. It is understood that, should this application for employment contain any willful misrepresentation or omission, reasonable proof of this fact will be sufficient justification for rejection of my application or termination of my services when hired.

I confirm I have the permission of the referees I have provided on this form to pass their personal details to you. I understand and agree to Federal Land, Inc. using this and other data to create and maintain records on me and for statistical purposes in accordance with the Data Protection Act of 2012. I agree that this information will be kept for the duration of the recruitment process and for a period of time thereafter. Should I be employed I agree that this information will be kept for the duration of my employment and for a period of time following this. I am aware I have the right to request a copy of the data held on me.
Undertaking*
- I Agree

NAME OF FRIENDS/ RELATIVES EMPLOYED AT FEDERAL LAND & OCCUPATION

Full Name	Occupation

Consent*

I agree to receive communications from Federal Land, Inc. about this inquiry and that I have read the company's Data Privacy Policy. We assure you that the data you are providing us will be treated with utmost confidentiality.
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Name	Civil Status	Age	Occupation	School/Employer

Name	Civil Status	Age	Occupation	School/Employer

Complete Name	Relationship	Referral's Contact Number/s