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I hereby authorize you to furnish the Yates County Personnel Office with my medical and disability record. You are released from all liability in complying with this request. It is understood that all information furnished will be treated as confidential.
By typing your name into this field you authorize Yates County to consider this an electronic signature.
Exam Number and Title
If the date in answer to question 5 is less than one year ago, do not answer the following questions.
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