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R STREET CITY STATE ZIP Position Applied for Today's Date Signature OVERALL EVALUATION (PLEASE COMPLETE THIS SECTION) PLEASE RATE THE APPLICANT ON THE FOLLOWING MUCH ABOVE AVERAGE ABOVE AVERAGE BELOW AVERAGE AVERAGE UNABLE TO EVALUATE APPEARANCE DEPENDABILITY HONESTY INITIATIVE JUDGEMENT MATURITY WORK REFERENCE (PLEASE COMPLETE THIS SECTION IF MARKED) Name While Employed Employment dates Position From To Reason for Leaving Would you rehire? s Yes s No Explanation Comment.

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