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* 1. Name:

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* 2. Best phone number to reach you:

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* 3. Best email to reach you:

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* 4. What Position(s) are you interested in? (Please check all that you are interested in)

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* 5. Based on your work schedule and other commitments, Do you have the support to commit the hours required?

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* 6. Describe your reasons for wanting this particular role?

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* 7. Describe your strengths that will help you accomplish this role? 

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