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N the back of the Supplemental Page, if necessary. (A conviction will not necessarily disqualify an applicant for employment). Date Location Charge Continue on Next Page Sentence REFERENCES List below the names of three (3) persons (not related to you) whom we may contact to obtain a reference. Name Address Phone Relationship 1 2 3 CERTIFICATION, AUTHORIZATION AND RELEASE I hereby certify that the information contained in this application form is true and correct and authorize Altair.

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