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DateFormFilled MailTo ManagerPhone Address NameOfApplicant SSNumber PositionHeld DateOfEmploymentFrom DateOfEmploymentTo QualityOfWork Reliability ConductPerformance AbilityToWorkWithOthers EligibleForRehire Notes SignatureOfApplicant DateSigned ReferenceCheckCompletedBy DateRefCompleted TelephoneInquiry SpokeWith Mailing DateMailed