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He reason for discipline. Signed Waivers must clearly set forth the number of demerits, days of suspension or dismissal, and also bear the signature and title of the carrier official reflecting management acceptance. PLEASE WRITE PLAINLY FILL OUT IN INK ALL QUESTIONS MUST BE ANSWERED 1. Name in full Age 2. Address 3. City Telephone Number State ( Zip Code ) 4. I am a member of UTU Local No. Soc. Sec. No. 5. What railroad, bus line or other transportation industry were you employe.

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