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​​I certify that the facts contained in this application are true to the best of my knowledge and understand that employment resulting from this application may be terminated if falsified statements are discovered by Harmony House Care Homes, Inc. I authorize investigation of all statements contained in the application and grant permission for employers listed within to disclose any information regarding my employment and character. My consent is hereby granted to Harmony House Care Homes, Inc. to conduct an inquiry regarding me with the information contained within this application, solely for the purpose of establishing eligibility for employment with a Missouri Department of Mental Health, Division of Developmental Disabilities Contracted Provider.