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Registered Nurse - 0.4 FTE- Evening
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I certify that the information provided herein is correct and complete. I authorize Eagleville Hospital or its designated representative to investigate and verify any of the information I have provided herein. I authorize and release all persons including employers, schools, law enforcement and government agencies, and any other person who may have information relative to my abilities, from any and all liability of whatever nature by reason of furnishing such information.

Any misrepresentation (by omission, concealment, false, misleading or partial answers) may result in denial or subsequent dismissal from employment. I further acknowledge that a FAX or photographic copy of this release shall be as valid as the original.

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