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Dates Employed to Employer Job Title Supervisor Phone No. Duties Reason for leaving When submitting this application electronically I understand that my typed name serves as my signature. I certify that all statements in this application are true and accurate. I understand that making false statements is reason for being denied employment or for having my employment terminated. Signature Date. Check all that apply Summer Break Week-ends Winter Break Early Mornings Spring Break Late Evenings...

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