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* 1. Name

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* 2. Email

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* 3. Cell Phone Number

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* 4. Secondary Phone Number

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* 5. What is the best way to contact you?

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* 6. Date of Birth

Date

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* 7. Are you able to speak English?

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* 8. Are you eligible to work in the United States?

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* 9. The Common Grounds Training Program is a nine-week program that operates Monday through Thursday from 8:30 AM to 4:00 PM. Please initial to indicate your awareness of this commitment and ability to participate in all parts of the program if selected.

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* 10. Please tell us what brings you to this program and your goals for employment.

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* 11. How did you hear about the Common Grounds Training Program?

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