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4 S <br /> PLEASE ANSWER ALL QUESTIONS .- PLEASE PRINT <br /> Date of Appl .oation'a,. 1,,ql <br /> a � � -.}•- � Social Security No * <br /> Address <br /> Street iy Town State ode <br /> o. <br /> Home Telephone t o QS +1 <br /> Are you known to schools/references by another name? Yes 'W/ No <br /> . t <br /> If yes, by what name? 7 �SP <br /> Phone Q- <br /> In case of emergency notify: <br /> Address * C1 S <br /> Street Cit y -oown State Zip e <br /> Have you filed anapplication or been employed by the Town of Ma <br /> before? Yes No <br /> If yes, what department en <br /> Are you a citizen t <br /> ` e United States? Yes No <br /> not doy ou have ars Al ie . egistration Card? Yes No <br /> related to anyone in Town ermploy, please state : <br /> #■ m �w.n^�r.^ rrr�r..nrni. �rl.�n .- # ie ■*#ent <br /> + <br /> r <br /> Have you been employed by Massachusetts State$ County, City7 town or any <br /> Massachusetts Public Authority? Yes � N <br /> If }yes , within 2 years? Ye-s No <br /> Posit*onpp lied For.: <br /> ' <br /> Date you can start Arb ru currently employed? , <br /> F May we inquire of your present employer .. <br /> Are you a Veteran's Yes No If yes, Branch of Service <br /> Please list 3 references not relate o you. <br /> Name Address Phone Number <br /> • f 4x <br /> 5 <br /> f 10 <br /> r } �fJj L <br />