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No Injuries: o Yes o No Fatalities: o Yes o No Injuries: o Yes o No Next Previous Accident (Description) Date APPLICATION FORM (please answer all questions) In compliance with the Federal and State equal employment opportunity laws, qualified applications are considered for all positions with out regard to race, color, religion, sex, national origin, age, marital status, or the presence of non job related medical condition or handicap. Position(s) Applied for o Company Driver o Owner/.

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