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I understand that the information on the application will be kept confidential and provided only to representatives of the Clay County Public Health Center and its sponsoring agencies for purposes of evaluating this application. I do herby give Clay County Public Health Center permission to inquire into my background, including references, employment, licensure and/ or volunteer history as part of the application review process. I further give permission to the holder of any such records to release same to the Clay County Public Health Center and its sponsoring agencies.
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