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I certify that answers given in this form are true, accurate, and complete to the best of my knowledge. I authorize investigation into all statements I have made on this form as may be necessary for reaching an employment decision.

In the event that I am employed, I understand that any false or misleading information I provided in this form or interview(s) may result in discharge and/or legal action. I understand that if employed, I am required to abide by all rules and regulation of the employer and any special agreements reached between the employer and me.