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entirely voluntary and will remain confidential. Failure to provide the information requested below will not result in any adverse treatment regarding your application. If you do not wish to provide this information, check the box on Page 2, sign the form and return it with your application. Thank you. Last Name First Name Middle Initial Gender □ Female Date of Birth (MM/DD/YY) □ Male / / Ethnicity/Hispanic Origin Hispanic origin includes all persons of Mexican, Puerto Rican, Cuban, Ce.

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