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Get Records R9 5 402 A 2021-2024

5. Immunization Statement: In Compliance with Arizona State Law, the undersigned does hereby testify that he/she has immunizations against measles, rubella, diphtheria, mumps and pertussis that are current. Employee Signature: Date: Hire Date: (if different) Phone # 6-7. Verification of Fingerprint Registration (see A.R.S. 36-883.02.c, R9-5-203): Original signed Criminal History Affidavit dated Copy of the Applicant.

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