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I, THE APPLICANT(S) CERTIFY ALL INFORMATION IS TRUE, COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

I understand the statement above concerning the penalty of making a fraudulent statement. I certify that all information in this my application is true and agree to face the consequences associated with falsifying information.By submitting this form, I agree to have all submitted information verified.I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for termination, whenever discovered. I authorize the companies to conduct any investigation it deems appropriate concerning my application. I hereby authorize and request former employers, personal references, schools, government agencies, health care providers, and all other persons and organizations to disclose credit, criminal record, employment and any other information that may be sought in connection with this application. I hereby release all of the above mentioned from all liability in connection with those disclosures. I further authorize the companies to disclose to others any information it may have concerning my employment, character, and qualifications, including information gained from this application and the investigation of this application. I herein release the companies from all liability in connection with those disclosures.