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TATE ZIP STREET CITY STATE ZIP PERMANENT ADDRESS PHONE NO. ARE YOU 18 YEARS OR OLDER? ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS? YES NO (circle one) YES NO (circle one) EMPLOYMENT DESIRED DATE YOU SALARY CAN START DESIRED IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? POSITION ARE YOU EMPLOYED NOW? EVER WORKED FOR THIS COMPANY BEFORE? WHEN? REFERRED BY EDUCATION NAME AND LOCATION OF SCHOOL NO. OF YEARS ATTENDED.
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