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EMPLOYMENT EXPERIENCE <br /> Please list last 3 employers, present or most recent employer first. <br /> Employer Dates Employed From To <br /> Address Phone Number <br /> Job Title Supervisor's Title <br /> Description of Duties <br /> Reason for leaving Hourly Rate From To <br /> Employer Dates Employed From To <br /> Address Phone Number <br /> Job Title Supervisor's Title <br /> Description of Duties <br /> Reason for leaving Hourly Rate From To <br /> Employer Dates Employed From To <br /> Address Phone Number <br /> Job Title Supervisor's Title <br /> Description of Duties <br /> Reason for leaving Hourly Rate From To <br /> PERSONAL REFERENCES <br /> Please list 3 people you have known for at least 1 year not related to you. <br /> Name Address Phone # of years acquainted <br /> I authorize investigation of' all statements contained in this application for employment as may be <br /> necessary to determine eligibility for employment. I certify that answers given herein are true and <br /> complete to the best of my knowledge and I understand that, if employed, falsification statements on <br /> P g <br /> this application shall be grounds for dismissal. I understand and agree that, if hired, my <br /> employment in the City of Centerville, is for no definite period and may be terminated at any time. <br /> Signature Date <br />