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salina fix roof

Employment Desired


Name and Location of School Circle Last Year completed Did You Graduate? Subjects Studied and Degree(s) Received
Grammar School
High School
Trade, Business, or Correspondence School

Work Experience

Month/Year Name & phone number of Employer Position Salary Reason for Leaving


Please list three people, not related to you, who have known you at least one year

Name Phone Number Business Years Acquainted

Physical Record

Do you have any physical condition that may limit your ability to perform the job applied for?

In case of emergency, please notify:

I certify that all of the foregoing statements are true and correct to the best of my ability. I understand that misrepresentation or omission of facts is cause for dismissal.