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    Please furnish the names and addresses of two people to whom you are not related and by who you have not been employed.
    I certify that my answers are true and complete to the best of my knowledge.

    I authorize you to make such investigations and inquiries of my personal, employment, educational, financial or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.

    In the event, I employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.