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Al pay Hours worked per week Duties May we contact your present employer? [ Name of Employer ] Yes [ ] No [ ] Please contact me first Address Type of Business Name of Immediate Supervisor Supervisor’s title and telephone number Title of your position Reason for leaving Starting date Final date Starting pay Final pay Hours worked per week Duties May we contact your present employer? [ ] Yes [ ] No [ ] Please contact me first Employment Application - Page 4 Employment .

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