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STREET CITY STREET CITY STATE ZIP STATE ZIP PERMANENT ADDRESS PHONE NO. ( ) - No ARE YOU 18 YEARS OR OLDER? Yes ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS? No Yes EMPLOYMENT DESIRED / / DATE YOU CAN START ARE YOU EMPLOYED NOW? IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? EVER APPLIED TO THIS COMPANY BEFORE? WHERE? SALARY DESIRED WHEN? FIRST POSITION REFERRED BY EDUCATION NAME AND LOCATION OF SCHOOL *NO.

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