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EMBASSY OF THEREPUBLIC OF LIBERIATEMPORARY TRAVEL DOCUMENTLAISSEZPASSER NaturalBornNaturalized Mother146s Full NameCountry of OriginNationalityCitizenship StatusNaturalization DateLivingDecease. e Master 1 Master A Utility Security Master etc You may refer to the lock report provided to your department by Lock Key Services for the correct key designation Building PLEASE DO NOT WRITE IN THIS SPACE Department Authorization Signature Departm Have you ever worked for Big Lots before Yes No If yes when and where If hired can you supply proof that you are legally entitled to work in the United States for any employer Yes No Do you have friends or relatives working for us Yes No If so who C Network ID tudent Loca l Address Street AptBox City State MI End Sponsor will pay for the following check all that apply Full Tuition Health Services Partial Tuition indicate percentage or amount Medical Insurance Mandatory Fees Yes if yes state amo 7336315 370 A57577ropostale 7207336795 325 ALDO 7207336179 600 American Eagle Out64257tters 3036633904 185 Ann Taylor Factory Store 3036883335 670 ArcTeryx 3035865567 830 SICS Outlet 3036888699 802 Banana Republic Factory Outlet 3036889116 340 GH Bas Jr etc Current Address STREET ADDRESS APT CITY PROVINCE POSTAL CODE PREVIOUS ADDRESSES within last 3 years STREET ADDRESS APT CITY PROVINCE POSTAL CODE STREET ADDRESS APT CITY PROVINCE POSTAL CODE Date of Birth Social Insurance Number MONTHDAYYEAR O Jr etc Current Address STREET ADDRESS APT CITY PROVINCE POSTAL CODE PREVIOUS ADDRESSES within last years STREET ADDR ESS APT CITY PROVINCE POSTAL CODE STREET ADDRESS APT CITY PROVINCE POSTAL CODE Date of Birth Social Insurance Number MONTHDAYYEAR OP Do you own rent your house rent an apartment Applicants Home Environment Information Do you presently have a dog or have you owned a dog before Name Breed MF Age Are there cats in your home no yes how many Are all of your pets spayedneutered If not S citizen Yes No If you answered Yes to the question above please respond to the following two questions If your answer was No skip to the following section Are you HispanicLatino Yes No Indicate your race by choosing American Indian or Alaska Native Last name First name Middle initial Curre nt Address Permanent Address if different from the current address Message Phone Alternate Phone mail Social Security Number New Application Reapplication For training to begin Fall Semester indic ate year A Man ager Type of Employment Desired circle one Full Time Part Time When can you start Hours Available circle one Days 10am 5pm Nights 5pm Midnight Have you ever been convicted of a felony Yes No If yes when Where Charge Do you have reliable tra CoachAthletic Director Signature Date 14438 814 201415 ENTRY DEADLINE POSTMARKED BY MARCH 27 2015 DEXTERUSBC High School AllAmerican Team COACHESATHLETIC DIRECTORS NOMINATION FORM DEXTERUSBC HIGH SCHOOL ALLAMERICAN INFORMATION The United Stat l l EMBASSY OF THEREPUBLIC OF LIBERIADIPLOMATIC/OFFICIAL/REGULAR VISADate Of irPlace of Birth (City/Country)Nationa VISA REQUIREMENTS1. Applicant must provide a copy of his/her Yellow Book ( Internati HEALTH COVERAGE ENROLLMENT FORM EMPLOYEE/PARTICIPANT INFORMATION SOCIAL SECURITY NUMBER CITY MALE FEMALE HOME PHONE SPOUSE INFORMATION HEALTH COVERAGE ENROLLMENT FORM EMPLOYEE/PARTICIPANT INFORMATION SOCIAL SECURITY NUMBER CITY MALE FEMALE HOME PHONE SPOUSE INFORMATION IF N