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Yment Specialty Stores Employment EMPLOYEE to complete / Print or Type NAME SEX UFCW Union # Male STREET ADDRESS Female SOC. SEC. NUMBER CITY STATE ZIP DATE OF BIRTH DATE FIRST EMPLOYED IN INDUSTRY TELEPHONE (DAYS) DATE LAST EMPLOYED IF NOT CURRENT ANY OTHER SURNAME e.g., maiden I AM PLANNING TO RETIRE SOON ARE YOU WORKING AT PRESENT IN CALIFORNIA UNDER A UFCW CONTRACT? IF NO, PLEASE ADVISE YOUR CURRENT WORK STATUS Yes Yes No No Complete your employment history below be.

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