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Get Work Permit Application

Le Nickname/Maiden/Other Weight Place of Birth Hair Soc Sec. No. Eyes Street Address Street Address City State ZIP Code State ZIP Code Mailing Address Mailing Address City E-mail Address Driver s License/State Cell Phone Home Phone Scars/Marks/Tattoos Place of Employment U.S. Citizen Yes Alien Reg. No. HAVE YOU EVER BEEN ARRESTED? Occupation No If No List Country Passport No. If Yes List ALL Arrests on the back of application Please note that the City of Elko must deny any.

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