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POSITION DESIRED: NAME: SOCIAL SECURITY NO. (Last) (First) (MI) ADDRESS: (Street) TELEPHONE: Home: (City) Work: (State) Cell: May we call you at work? (Zip Code) Email: Yes No IN CASE OF EMERGENCY NOTIFY: (Name) Can you, after employment, submit verification of your legal right to work in the United States? Have you applied for this position within the last six months? Have you ever been employed by the City? Yes No Yes No If under age 18, can you furn.

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