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Position Applied For
Date of Application
Date of Availability
Last, First, MI
Social Security Number
How many days were you ill during your last year of employment?
Is your mental and physical condition such that you could fulfill the requirement of the position for which you are applying?
Explain if you wish
Were you previously employed by us?
If so when?
Please list any friends or relatives working for us
Name and relationship
Why did you leave your most recent employment or why do you wish to leave?
Have you ever been convicted of any misdemeanor of felony, including any major traffic offense or had such a conviction purged?
If yes please explain
Person to be notified in case of accident or emergency
Name, address, phone number
Are there any other experiences, skills or qualifications, which you feel would especially fit you for work with our district
Add here any additional information about your self you may care to give us which you believe we should know in order to arrive at a true evaluation of your qualifications