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E EMPLOYMENT 1. Name: Last ADVENTURE PLAYGROUND First 2. Address: Street Middle Initial Apt. No. 3. Home Phone: City Work Phone: 4. Date of Birth State Cell Phone: 5. Social Security # Relationship 8. Are you over 18 years of age? Yes E-mail: 6. Driver s License # 7. Do you have any relatives who currently work for the City of Berkeley? If yes, name of relative: Zip Code Yes State No Department No 9. Have you ever been convicted of a felony? Yes No 10. Please describ.

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