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Get Human Resources Department 3801 West Temple Avenue, Pomona, Ca 91768-4023 Telephone (909) 869-3733

Application for Staff Employment Applicant Information Name: Last, First, Middle Initial Home Telephone Number Address: Street, Apartment or Space Number Work Telephone Number City Are you 18 years of age or older? State Yes Zip No Email Cellular Telephone Number If an offer of employment is made, can you provide proof of your legal right to work in the U.S.? Have you been previously employed by Cal Poly Pomona or the CSU System or any other state agency? Yes No Yes No If Yes, li.

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