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Please list four references; include superintendents and principals under whom you have worked.

I authorize investigation of all statements contained in this application. I understand misrepresentation or omission of facts is cause for dismissal without notice at any time during my employment. I agree, if employed, to follow all rules and regulations of the district. I understand, by state law, the board of education must require all employees to submit a health certificate from a physician along with a tuberculin test, at my expense. I agree to promptly notify the district of any change of address during my employment.