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Applicant Information

This application will take approximately 45 minutes to complete. You may save your work and return at a later time. Responses are saved and submitted when you click the Next or Done button on each page of the survey. You may go back and edit your answers at a later time.

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* 1. First Name

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* 2. Last Name

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* 3. Preferred Nickname

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* 4. Primary Email (LSS will use this email for all correspondence, including receipt of this application and next steps.)

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* 5. Primary Phone

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* 6. Secondary Phone

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* 7. Home Address/Street (example:123 Main Street)

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* 8. Home Address/City, State zip code

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* 9. Current Employer: Name of Business/Organization

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* 10. Current Title

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* 11. Business Address (example:123 Main Street, Weymouth, MA 02190 - for self employed, enter 'N/ A')

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* 12. Current Supervisor Name (if self-employed, indicate 'Self')

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* 13. Supervisor Title (If self-employed n/a)

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* 14. Supervisor Phone (If self-employed n/a )

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* 15. Supervisor Email (If self-employed n/a )

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* 16. How did you hear about Leadership South Shore?

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* 17. Have any other employees at your business completed Leadership South Shore?

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* 18. How long have you been a resident in or worked in the South Shore area?

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* 19. LinkedIn or Website (Optional: include link(s) to site(s) you'd like to share. You may include multiple links.

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* 20. Please List your Volunteer Experience/ Community Involvement. (Include dates, i.e., 'Food Pantry 3x Annually 2020-Current)

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