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SS (STREET/P.O.BOX) CITY STATE ZIP CODE PHONE (INCL AREA CODE) ( IN CASE OF EMERGENCY NOTIFY (NAME, ADDRESS, PHONE (INCL AREA CODE) , ,( ) (See Footnote No 1) - ) YES FORMER WESCO EMPLOYEE DATES YES FROM NO LOCATION - IS YOUR AGE: UNDER 18? SOCIAL SECURITY NO - NO - (See Footnote No 2) ARE YOU LEGALLY AUTHORIZED TO WORK IN THE US? TO YES NO DATE AVAILABLE SALARY REQUIREMENTS US MILITARY HISTORY (See Footnote No. 3) ARMED FORCES RESERVE BRANCH OR NATIONAL GUARD ACT.

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