Jensen Builders Ltd | Voluntary Survey

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EMPLOYEE OWNED

Name

Phone

Address

Date

Referral Source

Friend

Relative

Walk In

Employment Agency

Other

Sex

Male

Female

Ethnic Origin

White

Black

Hispanic

Asian/Pacific Islander

American Indian/Alaskan Native

Other

Position Applied For

Name of Referrer

Source Name

Name of Employment Agency

List Source

Check Any of the Following That Apply

Vietnam Era Veteran

Disabled Veteran

Disabled Individual

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