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*Factors such as age and time of the offense, seriousness and nature of the violation and rehabilitation will be taken into account.



Include School Name, City & State, Major Course of Study and Highest Grade Completed

REFERENCES Give names of two persons to whom you are not related and by whom you have not been employed, such as: teacher, coach, pastor/priest, etc.

EMPLOYMENT HISTORY (Begin with most recent position)

**If you have no previous employment, just leave this section blank.

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