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FORMER / CURRENT EMPLOYERS

REFERENCES: 3 Required - Not related to applicant

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have or give, personal or otherwise and release the company from all liability for any damages that may result from utilization of such information.