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First Name
Middle Init
Last Name
Applying For Position
Present Address
City
State
Zip
Phone
Work Phone
Cell Phone
U.S. Citizen
If not a U.S. Citizen, have you legally declared you intention to become a U.S. Citizen
If 'NO' on declaring U.S. Citizen, explain
Will you be at least 18 years of age and less than 35 years of age on or before November 4, 2014?
Do you have a driver's license?
Are you a high school graduate or equivalent (G.E.D.)?
Have you ever been convicted of a felony?
If 'YES' on Felony conviction, give date, place of arrest and offense.
The Civil Service Law prohibits classified employees from holding public office. Do you hold any office of this type at the present time? Such as precinct committee - person?
If 'YES' on elected official, explain.

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