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: Date: Middle: Street Address: Home Phone: City, State, Zip Business Phone: Have you ever applied for employment with Jefferson County? If yes: Month & Year NO YES Department: Position Applying For: Pay Expected: Department: Are you available for full time work? If not, what hours or schedule can you work? You may need to work overtime. Will such a requirement create a problem for you? Are you legally eligible for employment in the United States? If no, please give reason. Whe.

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