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12. About you:
14. First Name*
15. Last Name*
17. Telephone Number*
18. E-mail Address*
22. About your new job:
24. Name of the Company*
26. City*
28. Job Title*
30. What type of industry is this position?*
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32. Start Date*
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34. Hourly Wage ($)*
35. Hours Per Week*
37. Is this considered (Select One)*

    1. Full-Time

    1. Part-Time
39. Benefits (Select One)*

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41. Did you find this job through *

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43. If Other, please list
47. Thank you and Congratulations on your New Job!
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