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Rehire Form

Dated:

In order for us to evaluate you current status and qualified position, please complete the following:

Personal Information:

Name:

Taxation Identification Number:

Address:

Home Phone Number:_

Work Phone No:_

Current employer:_

Previous Employment Information:_

Original Hire Date:

Position:_

Department:_

Review date:

Position Number: _

Salary:_____[Dollars]

Return date:_

Emergency Information:

Name:_

Phone:

Address: _

Relationship: _

To my best knowledge the above iniormation is correct.

Signature: _