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APPLICATION AUTHORIZATION

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application for employment will be considered grounds for termination.

I authorize Dwight Andrus Insurance to investigate my work experience and any other matters related to my suitability for employment. I further authorize my former employers to disclose any and all information they may have concerning my previous employment. In addition, I hereby release the company from all liability for any damage that may result from utilization of such information.