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* 1. Last Name 

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* 2. First Name 

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* 3. Date of Birth

Date

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* 4. Your Email Address

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* 5. Phone Number

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* 6. Status in Canada

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* 7. Are you currently working?

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* 9. Highest level of education completed?

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* 10. What experience do you have related to CompTIA A+, CCNA or IT In General?

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