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Get VA SP-170-B 2020-2024

ICATION Applicant Name: Social Security #: (LAST) (FIRST) (MIDDLE) Address: City: Date of Birth: Cellular Phone: Work Phone #: ( ( State: Home Phone #: ( ) ) Email: ) Driver s License #: Years of experience as automotive mechanic: ZIP: State: Current Employer: Employer's Address: Station #: City: ZIP: Have you ever been certified as a safety inspector in Virginia? Yes No If yes, have you ever been suspended from the inspection program? Yes No Where were you.

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