The Job Center

Sunday May 18, 2008

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Job Bank Registration The contents of this form will be submitted to Gladys Willis, for questions please contact her at (937)225-5627. Required fields are bold and red with asterisk(). Registrant Information: First Name: Middle Name: Last Name: Social Security Number (optional); Street: City: State: Zip Code: Primary Phone: E-mail: Education Education Level: Work History Current employment status? Area of work experience: Years of Experience? Additional area of work experience: Years of Experience? Additional area of work experience: Years of Experience? Your current pay rate? Lowest pay rate you will accept? Additional Information Currently receiving public assistance? Type of public assistance receiving? Do you have a valid driver license? Do you have a valid commercial license? Primary means of transportaton? How did you hear about the Job Bank/Job Center? top
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Job Bank Registration