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NAME First Middle Last PRESENT ADDRESS Street UNTIL City State Zip PHONE PERMANENT ADDRESS if different EMAIL List all states in which you have resided during the last five years Are you authorized to work in the United States Please indicate level preferred Elementary Middle School Yes No High School Please list subjects and extra-curricular activities in order of preference Version 8-2014 CERTIFICATION Endorsement Area s Expiration Date Note Must hold or be eligible for NH certification....
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