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First Name *
MI. *
Last Name *
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Date of Birth	DecemberJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember22010203040506070809101112131415161718192021222324252627282930312024
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Education	High SchoolVo-TechCollegePost Grad.
Desired Wage	Select PeriodPer HourPer Year
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Full Time Week Days	1st2nd3rd
Weekends	1st2nd3rd
Part-Time	Days Evenings
Marital Status	SingleMarried Exemptions
Exemptions
Employment Eligibility Verification	Authorized YesNo
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