EMPLOYMENT

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Terms of Agreement *

I hereby authorize the company and its agents to request any information concerning my driving record. I hereby authorize any persons having knowledge thereof to provide such information to the company and/or its agents, and I hereby release from liability and agree to hold harmle3ss any person who furnishes such information in good faith. A copy of this form or online submital shall have the same effect as original.

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Tel: 561-379-3967

6889 High Ridge Rd. Lake Worth, FL 33462