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Address City State �ip <br />� �C� t� � � �o� a ��� k � -� � �, �Z.i ��r � <br />� �� �i <br />Supervisor Tit�e & 1*Tame P�one No. May we coniact? <br />{ ) Yes I�To <br />Dates of Employment Hours Wor�CedlVVe�k Job Ti�ie ��� � j V'�' Last Salary or �Iouriy Wage <br />��C�,� � � � � --�1�Y��, Z� C�� � Q -� �� � �� � � �e� <br />� <br />R�ason for Leaving: <br />�-� p t�u c� � � . C.;� �-�� YY�, G��l,� � S�oc� � �. C� �c �` Si o � -� �c� � � r� � 5 � �'�� r,�. <br />� � <br />Specific Duties: �1�,� �'1. � �� � Gt.-� � �' C.Y1 �� <br />� ��C� 1 l� �i %. �. j 1�'�JY C 1 � � �.� � � Yl #��C.�C�.� Y1 � <br />��i � ��Y1-�G�C� �S <br />' ' ��; � � Y �� Y1 `��1 � Y � (i�..� �� . <br />� <br />C�. � �� � � ��. � � � e.� -��� <br />� . <br />� � <br />, f / <br />�..-� c� �� --�r�� � <br />s � u 1 � ��c �.�� �ss ��.�.� Sna -� <br />� �, <br />� � <br />P <br />�,t� �c� �d ��� i � 1�.� ��-��.�d �� ���t <br />C���� Z � �� . � � � �- <br />� � �C,�� , t�� �� �C� � � ' ' � <br />� �� � �� � ��. ���� � � � �� � � � � <br />���� � �. � _ � <br />' ,` c� � � c�'�..� a�..�c� �� S c ���.-� ` � �I� �.� t� n� �-s <br />l ��5�/ D�-� , p �ri . <br />� C`� �. �r <br />� � �s �� � t <br />� 5� .�e <br />�� �� � <br />�� ��� � � <br />�� ��� l f <br />� 1�. ���.��� � � � .5 i� �'�� � c�rr�rn+-�}--�.� , <br />� v t ���,�,� �f � <br />� ��� � <br />Address <br />�� �x �%��' �- � ir� � <br />�� <br />Supervisor Title & Name <br />i�o ��r� � � � ��s� ��.�� <br />Dates of ��ployment �-iours Warked/Week <br />-t'n . ,o . . „ . _. _ � � t�. � � i A �► ,- _ � r.r, , f l � � <br />�.,��` �� (�i�` �.-j ��� � -- � � �� i `�`� % � �-i�� ��' <br />Reason for Leav�ng: <br />C��y <br />� ��� � <br />Phone No. <br />c � <br />Job Title <br />�C.l�Y� <br />Sta�e Zip <br />�� <br />May we contact? <br />Yes Na <br />Last Salary or Hourly Wage <br />G�1 d ��� � r� �S� -� E-� �a.,�� � . � r��� <br />Specific Duties: <br />i c;��t� ��c,� �. �����e... <br />�o���vc. c�-� �� �� <br />Have yau eve� been iermina�ed from a previous employer? Yes I�o <br />if yes, state the narr�e and address of co�npan�, date of deterr�ination, an reason for tern�ination {do not �nclude lay�ff or sta�f reduction). <br />City of Arden H�[!s * 1245 Wes� �igt�way 96, Arden H��1s, �iN 551 �2 *{65�) 634-�120 <br />