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� <br /> + <br /> •� � _ K ► {ate*...ter. <br /> .* k •x + '+� �y:�'.W. i . ' R...Y '},;r f ,*'fi. fit. }1 ' <br /> QUESTIONS - PLEASE PRINT. _ - <br /> ' n 5 <br /> 7 Date Applications <br /> 7?-OYS <br /> e so al' Security No <br /> k <br /> Address :� R 3 ..r. - <br /> Street City or Town state Zip Code <br /> Home Telephone <br /> � �� -,r i ;r.ti, ,': rt • rr <br /> Are# yowl eereces by ate a Yes o <br /> ,,. .+ <br /> _ y J 1• f'y S w pfd• f <br /> If <br /> l <br /> yes, by what name? <br /> In ase of emergency nt <br /> • fy : Phone <br /> Address :., <br /> 4Street <br /> City or 'Town State Zip Code _ <br /> Have you Filed ars application or been employed by the 'down of Ma pee <br /> bore Yes No <br /> If e ' what department? when? - <br /> kr . you a citizen of the United States? Yes. No ... <br /> If not, do -you have an Alien RegistrationCard'? Yes No <br /> gelated to anyone in 'Town empio , please state <br /> Name - Department <br /> Have you been employed by Massachusetts S te, C unty, C itry v w or- any = ` <br /> Massachusetts ' Public Authority? Yes No <br /> If- yes, within 2 years? Yes N o .. <br /> F REP <br /> `. .� esu <br /> o1 .� <br /> Applied <br /> a start �: ? � Ara u currently employed .. A <br /> Date you c . � � • <br /> May a i.nquire of your present employer? - <br /> Yes o • l es Branch Service <br /> Are you •. Veteran? � <br /> ER <br /> lease list 3 references not related. to you. <br /> Name - Address Foe Number <br /> j Ke-j.?f-�a <br /> *, ••, <br /> ir-3 <br /> � , <br />