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Ent/Unit # City Phone: ( State ) ZIP Code E mail Address: Date Available: Social Security No.: Desired Salary: $ Position Applied for: YES NO Are you a citizen of the United States? YES If no, are you authorized to work in the U.S.? YES NO YES NO Have you ever worked for this company? If so, when? Have you ever been convicted of a felony? If yes, explain: Education High School.

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