Persons not related to you, clergy or co-workers that you have know at least one year.
I certify all statements made in this application are, to the best of my knowledge, true and correct. Should any of the statements be subsequently proven inaccurate, I understand the employer may cancel my employment. You have my permission to contact my previous employers.
"FAILURE TO ANSWER TRUTHFULLY MAY RESULT IN THE FORFEITURE OF WORKERS' COMPENSATION BENEFITS"
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