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AFTER COMPLETING PLEASE SEAL THIS PAGE IN AN ENVELOPE IF MAILING OR DELVIERING IN PERSON. DO NOT INLCUDE WITH EMAILED APPLICATIONS DATE ADDRESS Which Ethnic Group do you consider yourself African American Asian/Pacific Islander Hispanic Caucasian Sex Male Female Are you a veteran Yes Are you or do you consider yourself disabled. Signature of Applicant If there is a particular employer you do not wish us to contact please indicate which one How did you hear about Republic Bank s Employment...
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