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R WHAT POSITION ARE YOU APPLYING? OTHER CIRCLE SHIFT AVAILABLE TODAY'S DATE DAYS STREET ADDRESS APT. # CITY STATE ZIP NIGHTS DESIRED WAGE CIRCLE APPROXIMATE TRAVEL DISTANCE $ 10 MILES /PER HOUR 20 MILES 30 MILES 40 MILES HOW DID YOU HEAR ABOUT US? NEWSPAPER? WHICH ONE? EMAIL ADDRESS INTERNET? WHICH WEBSITE? YELLOW PAGES? FRIEND - WHO? OTHER? (PLEASE LIST) OUTDOOR SIGN? HOME PHONE CELL. PHONE MESSAGE PHONE ( ( ( ) ) ) FIRST JOB REFERENCE NAME AND PHONE - - YES.
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