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Get UNCG Residency Questionnaire (Short Form)

U ever worked outside of North Carolina?  Yes  No NAME _____________________________________________________________________________________________ PAGE 2 12. Please list ALL of your employment for wages in the past 24 months (include a separate sheet if needed): Job Title Employer Address (City, State) From (mo./yr.) To (mo./yr.) Hrs/Week __________________________________________________________________ ________/___________/____________/___________ __________________________.

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