Get CSC Form 665
Yes □ No □ Yes □ No □ □ Yes □ No Details of action taken (sentenced length of suspension, amount of fine, etc.) Yes □ No □ E. Safety Awards Have you ever received a safety award? Yes □ No □ If yes, give details, including date received Have you ever received a citation for safe driving or for being a safe worker? Yes □ No □ If yes, give details, including date received If you had more than three traffic violations or two accidents within the last 5 years, provide.
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