ࡱ> ~ ybjbjVV 4<<_____sssssH V))))lp[]]]]]]@!#]_]__))  _)_)[[S{)GsjkG 0H sz$PTz${z$_{]]TH z$ %: AUTHORIZATION FOR RELEASE OF INFORMATION If Approved, please submit a copy of this form with the appointment papers. (Please print all responses, and the account information must be completed at the bottom of the page before this form will be processed.) If any part of this form is left incomplete, the form will be returned to the hiring department. I, FORMTEXT      , applicant for employment with Southern Illinois University Edwardsville for the position of  FORMTEXT      , hereby authorize a review of and full disclosure of all employment, education, and criminal and credit history information concerning myself, including any conviction, to any duly authorized agent of Southern Illinois University Edwardsville. I understand that any information obtained by such background investigation, which is acquired as a result of this release authorization will be considered in determining my suitability for employment with Southern Illinois University at Edwardsville. I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information; and I do hereby release said person(s) from any and all liability which may be incurred as a result of collecting and considering such information. A photocopy or facsimile of this release form will be valid as an original thereof; even though said copy does not contain an original writing of my signature. I have read and fully understand the contents of this "Authorization for Release of Information". You must answer the following questions and provide any information as requested: 1. HAVE YOU EVER USED ANOTHER NAME? >>>>>>>>>  FORMCHECKBOX  YES OR  FORMCHECKBOX  NO IF YES, LIST THE NAMES HERE OR ON AN ATTACHMENT. IN THE LAST TEN YEARS, PLEASE PROVIDE THE FULL ADDRESS OF THE LOCATIONS IN WHICH YOU HAVE LIVED, WORKED, OR ATTENDED SCHOOL HERE OR ON AN ATTACHMENT.  FORMTEXT       FORMTEXT       FORMTEXT       NOTE: As part of the background information that you provide on this application, you are not required to provide, and you shall not voluntarily provide, SIUE with any information regarding any conviction/arrest records pertaining to you that have been sealed or expunged. A conviction record will not necessarily be a bar to employment; factors such as age at the time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account in terms of the position applied for. Misrepresentation or omission of facts in your response to any question will be cause for rejection of your application or termination of employment. HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR, FELONY OR PLEADED NO CONTEST? >>>>>>>>>  FORMCHECKBOX  YES OR  FORMCHECKBOX  NO IF YES, IDENTIFY, ON AN ATTACHMENT, ALL CONVICTIONS BY PROVIDING AN EXPLANATION INCLUDING DATE, CITY, STATE, AND CHARGE. 4. HAVE YOU EVER BEEN PLACED ON COURT SUPERVISION? >>>>>>>>>  FORMCHECKBOX  YES OR  FORMCHECKBOX  NO IF YES, EXPLAIN INDICATING DATES, CITY, AND CHARGE PRINT NAME (First, Middle Initial, Last): FORMTEXT      ADDRESS: FORMTEXT      CITY, STATE, ZIP: FORMTEXT      TELEPHONE: FORMTEXT      SOC SEC NO.: FORMTEXT      Banner ID: FORMTEXT      BIRTH DATE: FORMTEXT      STATE DRIVER'S LICENSE NO.: FORMTEXT      STATE FORMTEXT   SIGNATURE:DATE: FORMTEXT      By my signature on this release of information, I acknowledge that Southern Illinois University Edwardsville did not inquire about any information regarding conviction/arrest records that have been sealed or expunged. To be completed by the hiring unit: Posting #: FORMTEXT      Type of Position:  FORMCHECKBOX  Faculty  FORMCHECKBOX  Admin/Professional Staff  FORMCHECKBOX  Civil Service  FORMCHECKBOX  Grad Asst  FORMCHECKBOX  Student AIS Budget Purpose/Acct Title to be charged: FORMTEXT      HIRING UNIT/CONTACT PERSON/CAMPUS BOX: FORMTEXT      Chancellor/VC: FORMCHECKBOX  Chancellor  FORMCHECKBOX  Academic Affrs  FORMCHECKBOX  Admin  FORMCHECKBOX  Student Affrs  FORMCHECKBOX  University RelationsTo be completed by HR:Approved for offer: FORMCHECKBOX  YES  FORMCHECKBOX  NOHR Representative Signature:Date: SIUE-Credit Report Authorization and Privacy Disclosure Form Southern Illinois University Edwardsville, employer, hereby provides written notice to the application/employee of its intent to req+w  d e f i j t u ®zhQh7Q2j!hEh$CJOJQJU\^JaJ,jhEh$CJOJQJU\^JaJ#hEh$CJOJQJ\^JaJ#hEhal5CJOJQJ^JaJ hEhalCJOJQJ^JaJ!hal56B*OJQJ^Jph'hzUhal56B*OJQJ^JphhzUhal5>*OJQJ^JhzUhal5OJQJ^J#hEhalCJOJQJ\^JaJjhalhalCJU+w d e f i  sykde$$Ifl40$ * f!04 laf4yt9J$If $$Ifa$gdal  @ B ϽϽϽhVB&hEh$56CJOJQJ^JaJ#hEh$6CJOJQJ^JaJ/hEh$5>*B* CJOJQJ^JaJph2j hEh$CJOJQJU\^JaJ#hEh$5CJOJQJ^JaJ hEh$CJOJQJ^JaJ#hEh$CJOJQJ\^JaJ,jhEh$CJOJQJU\^JaJ1jhiACJOJQJU\^JaJmHnHu @ rlll$Ifkd$$Ifl4F*H 0    4 laf4yt9J@ B s t 23rlllllll$Ifkd $$Ifl4F@ * 0    4 laf4yt9Jx$Ifgd9Jl  & Fgdlgdldkd $$Ifl4**04 laf4yt9J "#1234?@NOPǶǞǃǶnVnE7hECJOJQJ^JaJ hEhZCJOJQJ^JaJ/j% hiAhiACJOJQJU^JaJ)jhEhlCJOJQJU^JaJ5j hiAhiA56CJOJQJU^JaJ/jhEhl56CJOJQJU^JaJ hEhlCJOJQJ^JaJ&hEhl56CJOJQJ^JaJ&hEh$56CJOJQJ^JaJ hE56CJOJQJ^JaJMQVwxűűşŋyjUD,/j h`h9JCJOJQJU^JaJ h`h9JCJOJQJ^JaJ)jh`h9JCJOJQJU^JaJh$6CJOJQJ^JaJ#h62Jh$6CJOJQJ^JaJ&h62Jhl56CJOJQJ^JaJ#h62Jhl6CJOJQJ^JaJ&h62Jh62J56CJOJQJ^JaJ&h62Jh$56CJOJQJ^JaJ&hEh$56CJOJQJ^JaJ#hEh$6CJOJQJ^JaJ  &(*468:<PRT^`bdf꾬ꛃmUmC#h62Jh62J6CJOJQJ^JaJ/jh`h9JCJOJQJU^JaJ#h`h9J6CJOJQJ^JaJh9J/j h`h9JCJOJQJU^JaJ h`h9JCJOJQJ^JaJ#h`h62J6CJOJQJ^JaJ h`h62JCJOJQJ^JaJ4jh`h9JCJOJQJU^JaJmHnHu)jh`h9JCJOJQJU^JaJ8$Ifgd9Jl jkd $$Ifl *) t0644 lahyt`8:b$Ifgd9Jl jkd!$$Ifl *) t0644 lahyt`bdfV#SRIxsgd & FgdlgdA8gdZh^hgd62Jjkd1$$Ifl *) t0644 lahyt` fnv*,T^"'RSW\*+OV(+67?HǶǶǶضǶǶǶǶǗǗǶ؅qqq` hEhlCJOJQJ^JaJ&hEh$56CJOJQJ^JaJ#hEh$6CJOJQJ^JaJhDuBCJOJQJ^JaJ hEhA8CJOJQJ^JaJ hEhZCJOJQJ^JaJ hEhBbCJOJQJ^JaJ&hEhBb56CJOJQJ^JaJ&hEhZ56CJOJQJ^JaJ$HIP]^lmnoz{͵͚͉t\tJ;hE6CJOJQJ^JaJ#hEh2s6CJOJQJ^JaJ/jAhiAhiACJOJQJU^JaJ)jhEhlCJOJQJU^JaJ hEhlCJOJQJ^JaJ5jhiAhiA56CJOJQJU^JaJ/jhEhl56CJOJQJU^JaJ&hEhl56CJOJQJ^JaJ h56CJOJQJ^JaJhCJOJQJ^JaJLRTstvxzpX=Xp5jhiAhiA56CJOJQJU^JaJ/jhEhl56CJOJQJU^JaJ hEhlCJOJQJ^JaJ&hEhl56CJOJQJ^JaJ hE56CJOJQJ^JaJ#hEhBb6CJOJQJ^JaJ&hEhBb56CJOJQJ^JaJhE6CJOJQJ^JaJ#hEhZ6CJOJQJ^JaJ#hEh$6CJOJQJ^JaJMst bqskd$$Ifl0)004 la $Ifgd*gdZgdBbgd2s   $^b٭veN9N)hEhBbB* CJOJQJ^JaJph,hEhBb5B* CJOJQJ^JaJph hEhBbCJOJQJ^JaJ&hEh$56CJOJQJ^JaJ#hEhBb6CJOJQJ^JaJ hE56CJOJQJ^JaJ&hEhZ56CJOJQJ^JaJ/j-hiAhiACJOJQJU^JaJ hEhlCJOJQJ^JaJ)jhEhlCJOJQJU^JaJ bdxz|ْ}lT}}C1#jhrCJOJQJU^JaJ hEhZCJOJQJ^JaJ/jhEhCJOJQJU^JaJ hEhA8CJOJQJ^JaJ)jhEhA8CJOJQJU^JaJ,hEhZ5B* CJOJQJ^JaJph.jhiACJOJQJU^JaJmHnHu/jhEhBbCJOJQJU^JaJ hEhBbCJOJQJ^JaJ)jhEhBbCJOJQJU^JaJ*,@BDNPRlnȰȟpȰȟ^P8^^/jh*h*CJOJQJU^JaJh*CJOJQJ^JaJ#jh*CJOJQJU^JaJ/jYhrhrCJOJQJU^JaJ,hEhZ5B* CJOJQJ^JaJph hEhZCJOJQJ^JaJ.jhiACJOJQJU^JaJmHnHu#jhrCJOJQJU^JaJ/jhrhrCJOJQJU^JaJhrCJOJQJ^JaJ*Rle\\\\\\ $Ifgd*kd$$Ifl\d)b04 laIJt]H7 hEh*CJOJQJ^JaJ)jhEh*CJOJQJU^JaJ,hEh*5B* CJOJQJ^JaJph.jhiACJOJQJU^JaJmHnHu/jChrhrCJOJQJU^JaJhrCJOJQJ^JaJ#jhrCJOJQJU^JaJ,hEhZ5B* CJOJQJ^JaJph&h*5B* CJOJQJ^JaJph hEhZCJOJQJ^JaJ Lt?66666 $Ifgd*kd$$IflֈFj)$ TT2 04 laLNbdfprt~ҺңҒzҺҒeҒMҺҒҒ/j}hEh*CJOJQJU^JaJ)hEh*B* CJOJQJ^JaJph/jhEh*CJOJQJU^JaJ hEh*CJOJQJ^JaJ,hEh*5B* CJOJQJ^JaJph.jhiACJOJQJU^JaJmHnHu)jhEh*CJOJQJU^JaJ/jhEh*CJOJQJU^JaJ6kd$$Iflֈ !%)X $ 804 la $Ifgd*Һҩp^G5#hEhBbCJOJQJ\^JaJ,jhEhBbCJOJQJU\^JaJ#hEhBb5CJOJQJ^JaJ,hEhBb5B*CJOJQJ^JaJph hEhBbCJOJQJ^JaJ hEhzUCJOJQJ^JaJ hEh*CJOJQJ^JaJ.jhiACJOJQJU^JaJmHnHu)jhEh*CJOJQJU^JaJ/jhEh*CJOJQJU^JaJ ecZQQ $IfgdBb $Ifgd*kdO$$Ifl\F)~ 04 la  68TVXtv϶ϟ|gOgg7gg/jhiAhiACJOJQJU^JaJ/jDhiAhiACJOJQJU^JaJ)jhEhBbCJOJQJU^JaJ#hEhBb5CJOJQJ^JaJ hEhBbCJOJQJ^JaJ,hEhBb5B*CJOJQJ^JaJph1jhiACJOJQJU\^JaJmHnHu,jhEhBbCJOJQJU\^JaJ2jhEhBbCJOJQJU\^JaJ ^7kd$$Ifl)B*B*4 la $IfgdBb_kd$$IflF)F B*    4 la8:<VXtvx ppYG#hEhBbCJOJQJ\^JaJ,jhEhBbCJOJQJU\^JaJh*5CJOJQJ^JaJ#hEhBb5CJOJQJ^JaJ/jhiAhiACJOJQJU^JaJ/jhiAhiACJOJQJU^JaJ hEhBbCJOJQJ^JaJ)jhEhBbCJOJQJU^JaJ/j,hiAhiACJOJQJU^JaJ       ^ b d x z | ϶ϤjXJ2X/jhrhrCJOJQJU^JaJhrCJOJQJ^JaJ#jhrCJOJQJU^JaJ)hEhBb5CJOJQJ\]^JaJ&hEhBb5CJOJQJ\^JaJ hEhBbCJOJQJ^JaJ#hEhBbCJOJQJ\^JaJ1jhiACJOJQJU\^JaJmHnHu,jhEhBbCJOJQJU\^JaJ2jhEhBbCJOJQJU\^JaJ   b !KOkde$$Ifl40:)B*4 laf4 $IfgdBb[kdY$$Ifl40)PB*4 laf4p| ! ! !2!4!P!R!T!h!j!!ijqYA/j hiAhiACJOJQJU^JaJ/jf hiAhiACJOJQJU^JaJ/jhiAhiACJOJQJU^JaJ)jhEhBbCJOJQJU^JaJ)hEhBb5CJOJQJ\]^JaJ hEhBbCJOJQJ^JaJ#hEhBbCJOJQJ\^JaJ#jhrCJOJQJU^JaJ.jhiACJOJQJU^JaJmHnHu!!!!!!!!!")"*"+"9":";"C"D"R"S"T"W"X"u"~lT*CJOJQJ^JaJ,hEhBb5B*CJOJQJ^JaJph/j!hiAhiACJOJQJU^JaJ hEhBbCJOJQJ^JaJ)jhEhBbCJOJQJU^JaJ/jR!hiAhiACJOJQJU^JaJ!!"*"X"Y"v"9`kd#$$Ifl4F) B*    4 laf4 $$Ifa$gdBb $IfgdBbOkd>"$$Ifl40T)#B*4 laf4u"v"""""F#p&wFwGwQwRwxx xxx0x2x4x>x@xJxLx`x|gXFXgXX#j%h`h;+OJQJUjh`h;+OJQJU(jh`hiAOJQJUmHnHu#j#%h`hrOJQJUh`hrOJQJjh`hrOJQJUh`h;+OJQJUh=h)5_OJQJh=halOJQJhalOJQJh)5_OJQJ hEhBbCJOJQJ^JaJ&hEhBb6>*CJOJQJ^JaJv"w"}"~""""""vqqqG)$$d%d&d'dNOPQa$gd)5_gd)5_skdh$$$Ifl4\ E)R ,3 B*4 laf4 $$Ifa$gdBb $IfgdBb""""DrErttSv%w&wFw xxDxJxnx$Ifgd;+l gd)5_uest and review a consumer report/credit report from an outside agency as a part of its consideration and review of my application and suitability for employment at Southern Illinois University Edwardsville. In addition, if employed, I am hereby notified that prior to or at any time after my employment starts a consumer report/credit report may be requested for employment eligibility purposes. The employer, Southern Illinois University Edwardsville, will obtain its consumer report from VanElla Inc., or any Employment Screening Service Agency that the employer may choose. In accordance with the Fair Credit Report Act, I understand that I have the right to request a complete and accurate disclosure of the nature and scope of the consumer report/credit report received by the employer. In addition, I am entitled to receive notice if my application for employment is denied wholly or in part due to information contained in a credit report received from a consumer reporting agency, such as VanElla Inc. or any other agency as determined by the employer. If any information within the credit report is inaccurate or incomplete, I understand that I have the right to dispute this information with VanElla Inc. or the agency selected for the investigation. I understand that any consumer report/credit report or investigative consumer report will be used only for employment purposes as defined under 603 (b) and authorized under 604 (a)(3)(b) of the Fair Credit Reporting Act, as a report to be used for the solely purpose of evaluation for employment, promotion, reassignment or retention as an employee. I understand that the information obtained in my consumer report/credit report shall not be shared to external parties or parties not directly involved in the hiring process, without my prior written consent. Acknowledged and agreed to this FORMTEXT     day of FORMTEXT      ,20 FORMTEXT   .Employee s/Applicant s Signature Employee s/Applicant s NameSocial Security NumberDate  7/11 (previous editions are obsolete) `xbxdxhxjx>yHyyyyyyyyy޾ h=h)5_h9JCJOJQJ^JaJhalCJOJQJ^JaJ hEhalCJOJQJ^JaJh=h)5_OJQJh`h;+OJQJ(jh`hiAOJQJUmHnHujh`h;+OJQJU#j&h`h;+OJQJUnxpxrxtxvx7$$$$Ifgd)5_l kd&$$IflֈN V f!  t044 layt`vxxxxxxxp]JJJ$Ifgd)5_l $Ifgd;+l kd($$IflPFf!0*x t0    44 layt`xxxxxr_LL$Ifgd)5_l $Ifgd;+l kd+)$$IflFf!0*x t0    44 layt`xy.y0y:yy@yByDyHyyyrmmmmem$a$gd7Tgd)5_kd#+$$IflFf!0*x t0    44 layt`2&P:pE/ =!"#`$`% eDdT  C 0Alogo_150_btb%ǏnZPѧȂa\Dn%ǏnZPѧȂa\PNG  IHDR VtRNS["bKGD̿ cmPPJCmp0712`IDATXGXu8 oqsq3X ':A '8z>,;K{Ad ?b}E]CѓVVXAj䍏RzD5#vFZ>1JۨW;RNg]@%SHHIW3Owm0m^ZFQr u%|TjCn fW: ($7u #i*[EA0Z+~!4^__%h\y劶[lߕ'&_x&Zx j#/m;v7Ek+)|w؁ P֬.m27 CZ l)XYG7EktqpftװR[¢2' -*F'45U )= ғ*,X97peō`KPYxЄ4JO] q|"C%43pMѲ`UڮP;yKaG@^abbK^qKRԺ^Ye6[-Ϫ!<\ ]'CVAiiUڔ`fa2]!slj1d j  5![KK?_ǝT4YSu~q7de58)QKB`،trQ1i)8Hgה-x{~W[VBOq?0jn~ =尰10 .'CAX8^[TɿZ89ZI|ő-\“L's+0 '׿3fw)>Q!6˥3@p>7Hyn3o(NuS;j8yvt?Nv$w"HfD10kC=8? íYqɘP N];W=jTR=%}sM}×Eeԭr7bX-aLl3eܹjl'-m;-I7! Vo_$}S~Q37VQ,EU9xc~$3R/bR(A1.`JsJa"QQ\\:€#/Ҡ\B' |ÀΠ6̮Ф{Ttgw#r=vM*;ƺ}hglo/i?@ ; .1"+{kLI?xs\;>;lhE_fR!IENDB`$$If!vh5 5f!#v #vf!:V l40,,5 5f!/ 4f4yt9JjD$$If!vh5H5 5#vH#v #v:V l40,5H5 5/ / / / / / 4f4yt9JjD#$$If!vh5 55#v #v#v:V l40,5 55/ / / / / / 4f4yt9J$$If!vh5*#v*:V l405*/ 4f4yt9JvDeCheck10vDeCheck11vD}Text19$$Ifh!vh5)#v):V l t06,5)/ ahyt`vD}Text19$$Ifh!vh5)#v):V l t06,5)/ ahyt`vD}Text19$$Ifh!vh5)#v):V l t06,5)/ ahyt`vDeCheck10vDeCheck11vDeCheck10vDeCheck11tD-Text2$$If!vh505#v0#v:V l0,5054jD(tD#Text3$$If!vh555b5#v#v#vb#v:V l0,555b54tDText6vD Text10jD $$If!vh55$ 5T5T552 #v#v$ #vT#v#v2 :V l0,55$ 5T552 4tD Text9vDText13tDText4$$If!vh5X55 5$ 558#vX#v#v #v$ #v#v8:V l0,5X55 5$ 5584jD$$If!vh55~55 #v#v~#v#v :V l0,55~55 4vD Text14$$If!vh55F5 #v#vF#v :V lB*,55F5 / / /  / 4tDeCheck1tDeCheck2tDeCheck3vDeCheck19vDeCheck20U$$If!vh5B*#vB*:V lB*5B*/  4vD<Text15$$If!vh55P#v#vP:V l4B*,55P/ /  4f4pjD2$$If!vh55#v#v:V l4B*,55/ /  4f4vDeCheck14vDeCheck15vDeCheck16vDeCheck17vDeCheck18$$If!vh55##v#v#:V l4B*,55#/ / 4f4vDeCheck12vDeCheck13$$If!vh555 #v#v#v :V l4B*555 / / /  / 4f4$$If!vh5R 5,535 #vR #v,#v3#v :V l4B*5R 5,535 / /  / 4f4vDText16vDText17vDText18$$If!vh5 55555#v #v#v#v#v:V l t0,5 5555/ / / / / / / / / / / /  / yt` $$If!vh505*5x#v0#v*#vx:V lP t0505*5x/ / / / / /  / yt`$$If!vh505*5x#v0#v*#vx:V l t0505*5x/ / / / / yt` $$If!vh505*5x#v0#v*#vx:V lP t0505*5x/ / / / / /  / yt`$$If!vh505*5x#v0#v*#vx:V l t0505*5x/ / / / / / / yt`^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH DA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 6U6 Hyperlink >*B*phj@j ;+ Table Grid7:V0PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]   fHb | !u"`xy "#$&(*,./124= @ 8b !v""nxvxxx?@ABiu{)/2>Dr *6<KW]jv| %+AQ`p'-Wci{ P`iyFFtG$G$FTFTFTG$G$G$G$FFFFFFFFFFFG$G$G$G$G$FtFG$G$G$G$G$G$G$FFF8@0(  B S  ?Text19Check10Check11Text2Text3Text6Text10Text9Text13Text4Text14Check1Check2Check3Check19Check20Text15Check14Check15Check16Check17Check18Check12Check13Text16Text17Text18s +LBa|Qj  =^,Rq.az< > i 33333333ddeei|12FGG *=K^j} ,.Wjddeei|12FGG *=K^j} ,.Wjc<\t hh^h`o(.<\t-,*Z_N$A8Q ?IAiADuBE62J9JkKdPiSzU[)5_Bb galfu;+22sR&rXlcI&>lMH`*b]7TK@ZD(@vv  &&&lh@h h@hh(@hhh8@hh hD@h@hxUnknownG* Times New Roman5Symbol3. * ArialA BCambria Math"hףfףfwF"2"2n!24d3QHX ?7T*!xx(AUTHORIZATION FOR RELEASE OF INFORMATIONOIT Joyree Chura Oh+'0 ,8 X d p |,AUTHORIZATION FOR RELEASE OF INFORMATIONOITReleaseJoyree Chura2Microsoft Office Word@@=V@*G@*G"՜.+,0 hp  SIUE2 )AUTHORIZATION FOR RELEASE OF INFORMATION Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCEFGHIJKLMNOPQRSTUVWXYZ\]^_`abcdefghijklmopqrstuwxyz{|}Root Entry FGData D+,1Table[$WordDocument4SummaryInformation(nDocumentSummaryInformation8vCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q