REFERENCE RELEASE FOR APPLICANTS In exchange for consideration for employment

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REFERENCE RELEASE FOR APPLICANTS In exchange for consideration for employment by Nemont Telephone Cooperative, Inc., and subsidiary companies, I hereby authorize any company, person, or educational institution I listed as a reference on my employment application to disclose any information they may have regarding my qualifications for employment, including but not limited to: dates of employment, salary, job description, personal attributes, disciplinary action(s), and opinions regarding my job performance. I will hold the Company and the Company’s employees, directors, officers, and successors as well as any company, person, or educational institution I have listed as a reference free from liabilities, claims, and causes of action, known or unknown, contingent or fixed, for providing or receiving any information regarding my qualifications for employment. I also agree not to file any lawsuit or other action to assert a claim. BACKGROUND CHECK NOTIFICATION As a condition of employment, all finalists will be required to sign a reference release and be subject to a background check that may include but is not limited to criminal history record information. _____________________ Print Name ______________________ Signature ________________ Date

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