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Position Applying For:
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities
involved in the job or occupation for which you have applied? A review of the activities in such an occupation has
Are you under the age of 18?
If you are under the age of 18, can you provide required proof of your eligibility to work?
Last Year of Education Completed:
Attach Resume and Cover Letter
Tell Us About Yourself!
I certify that the answers given herein are true and complete. I authorize investigation of all statements contained
in this application for employment as may be necessary in arriving at an employment decision. In the event of
employment, I understand that false or misleading information given in my application or interview(s) may result in
discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
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Hope Smith (GM)
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