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Are you 18 years of age or older?*YesNo

Are you a U.S. citizen or approved to work in the United States?*YesNo

What document can you provide as proof of citizenship or legal status?*

Will you consent to a mandatory controlled substance test?*YesNo

Do you have any conditions which would require job accommodations?*YesNo

If yes, please describe accommodations required below.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?*YesNo

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case.

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