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<br /> bent 6y: HawCC OCET; 9747487; Oct-70-02 12:44PM; Page [i/(i <br /> _ Arm you currongy urtomployad7 _ Aro you wrtwntly employed <br /> _ # Weeks Unemployed Length of Employment <br /> _ Were you laid off? Weekly Hours <br /> Receiving unemployment Hourly Wage <br /> beneFltr? Employer Name <br /> Occupation desired Wage Expectation <br /> Full Time or Par[ Time Hours per week <br /> Reason for Work Geographic Location <br /> Step 1: Step 2: <br /> Step 3: S[ep 4: <br /> I, the undersigned, understand that the information provided in this form will be used only <br /> for the purposes of this Rural Develo mggnt Project funded program. The information will not <br /> be used outside of this program an~lll`Femaln pnvate. I agree to participate In a follow <br /> up phone interview 6 months following the comDletlon of this program. <br /> Signature of Partldpant Date <br /> <br />