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(Proof of Citizenship or immigration status will be required upon employment)

The New York State Human Rights Law prohibits discrimination in employment because of age.

Professional License or Registration

If you have a Professional or Technical License, Registration, Certification, or Permit complete the following:

Provide the past 5 years of employment as completely as possible.

Starting with your present or most recent employer, including summer employment. If space is insufficient; list on an additional page or attach resume. For any unemployed or self-employed periods, show dates and locations. All data must be completely filled in. DO NOT write “see resume”.