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TO APPLICANTS: Do not answer this question unless you have been informed about the requirements of the job for which you are applying. Are you capable of performing, in a reasonable manner, the essential job functions of the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is available. Yes No Applicant s Statement I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation.

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