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L functions of the position with or without accommodations? Yes No Work (which shifts)? Select: Work overtime? Select: Select: Provide a valid Drivers License? IF NECESSARY FOR THE JOB, ARE YOU OVER (Please mark one) 14 15 16 18 19 21 I WILL BE ABLE TO REPORT TO WORK DAYS AFTER BEING NOTIFIED THAT I AM HIRED. EDUCATION: Yrs. Completed Field of Study Graduate or Degree High School College/University Business/Technical Other (May include grammar school) MILIT.

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