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APPLICATION FOR EMPLOYMENT

Are you legally authorized to work in the United States? qYesq No Have you ever worked for El Pollo Loco before? qYesq No If yes, when? From To Location How did you learn of our organization? q Newspaperq School q Internet qReferralq Agency q Other_____ relatives currently working for El Pollo Loco? qYesq ...

Supplemental Farm Application - Personal Umbrella Product

Eligibility Questions Please answer the following questions. For any "Yes" response, please provide complete information in remarks area. 1. Does the farm operation include any manufacturing, processing or slaughtering? qYesq No 2.

Real Estate Errors & Omissions - All States

Building Characteristics a) Are functioning burglar alarms present? qYesq No b) Is all electrical wiring connected to functional and operational circuit breakers? qYesq No c) Are there functioning smoke and heat detectors in all units and/or occupancies? qYesq No d) Is aluminum wiring present in the ...

The Main Event® —Special Event Product

Is applicant the sole vendor/server of alcohol at event? qYesq No* *If no, list number of other vendors/servers serving alcohol: _____ b.

Kamy Kemp, M.D.

Have you had any kind of cancer? q q q q q q Right Left q qNo qLeft qRight qDate qDate q Left q Right q Date q Date qLeft qRight qDate qDate qLeft qRight qDate qDate qLeft qRight qDate qDate qLeft qRight qDate qDate q Left q Right q Date q Date qYesq No q q q q q q q If yes, specify: Mother q Age at diagnosis Post Menopausal q Grandmother q Age at diagnosis Post ...

WORKER'S COMPENSATION INJURY QUESTIONNAIRE

If yes, what?_____ qYesq NoWere you carrying anything when you fell? If yes, what?_____ How much did it weigh?_____lbs. qYesq No Did you twist when you fell?

specified professions supplemental hr management2 ...

Does the Applicant derive over 25% of revenue from providing interim management services or to clients for whom the applicant is a board member, officer, or over 3% shareholder or as a manager on a day-to-day basis? qYesq No b.

Community Association Professional Liability Application ...

Does the builder/developer or agent maintain representation on the board? qYesq No If "Yes", has control of the board been turned over to the association? qYesq No 2.

Employment Practices Liability Application - All States

Do more than 50% of all employees currently earn more than $100,000? qYesq No 3. a) Is the Applicant a Subsidiary of another organization? qYesq No b) Is the Applicant a franchisee of another organization? qYesq No c) Name of Parent and/or Franchisor and Location ...

Membership Data Form

TIAA-Cref, Valic) qYes qNo Have you ever been a member of ATRS? qYesq No Have you ever received a refund? qYesq No Form # 1 Revised 8/2009 1400 West Third, Little Rock, AR 72201 Phone (501) 682-1517 or (800) 666-2877 Fax (501) 682-2359 School Districts To be Completed by Member To be Completed by Employer School ...