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By filling out this form, I authorize Berry Healthcare and its representatives to perform a criminal record information check relative to my association with Berry Healthcare to perform applicable state law. I understand and agree that Berry Healthcare and its representatives, the Texas Bureau of Investigation, Division of Criminal Information and its official and employees shall not be held legally accountable in any way for providing this information to Berry Healthcare, and I hereby release said Agency and persons from any and all liability which may be incurred as a result of furnishing such information. I further understand that Berry Healthcare cannot provide me with a copy of the results of this criminal history record check.