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Get HI DOE OHR 600-001 2011-2024

(or continue) unless this statement is satisfactorily completed. Applicant/Trainee Legal Signature: ______________________________________________ Date: _______________________ MM/DD/YYYY IV. REVIEW BY PRINCIPAL, SUPERVISOR OR HIRING/PLACING AUTHORITY (See instructions on next page) Based on my screening of the information provided above, and subject to the validation of criminal history record check, I am satisfied that this person will not pose a risk to the health, safety and/or well-being.

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