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Ioned Personnel 5600 Fishers Lane, Room 4A-15 Rockville, MD 20857-0001 REFERENCE REQUEST FOR APPLICANTS TO THE U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS Insert name here Applicant s Name (Last, First, Middle initial) If the reference knows you by any other name, e.g., maiden name, please indicate that name here: Your name has been given as a reference by the individual identified above who has applied for appointment to the Commissioned Corps of the United States Public Health Service.

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