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Ge and belief the information given is correct. I understand that I am appointed information is inaccurate, I am liable for dismissal. Signature: Date: Full Name: Date of Birth: 18 Great James Street L Derry 028 71360070 46a High Street Omagh 028 82242595 12 Dunmore Street Coleraine 028 70357035 Email: info mparecruitment.co.uk www.mparecruitment.co.uk Recruitment of Permanent and Temporary Staff Co. Registration No. NI40246 Opt- Out of a 48 Hour Working Week Agreement The Regulations.

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