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Ve test date. Return the original copy of this form to a Department of Motor Vehicles (DMV) office unless DMV tells you to mail it to Sacramento. Make a copy for your records. If you have questions, please call the Employer Testing Program Unit at (916) 229-4404. DRIVER COMPLETES THIS SECTION (First PRINT DRIVER S NAME Middle ADDRESS CITY HOME TELEPHONE NUMBER ( DRIVER LICENSE NUMBER Last) STATE EMPLOYMENT DATE WITH THIS COMPANY (REQUIRED) WORK TELEPHONE NUMBER ( ) ZIP CODE ).

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