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Dress Are you legally authorized to work in the United States? Are You Applying For: F/T P/T Temp Yes No What Shift(s) Will You Work? Days Evenings May We Contact Present Employer? Nights Yes No EMPLOYMENT HISTORY - Begin With Most Recent Employment Dates From To Company Name City, State Titles and Duties – Supervisor’s Name Reason for Leaving: Dates From To Company Name Telephone Number City, State Titles and Duties – Supervisor’s Name Reason for Leaving: Date.

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