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	First Name: Last Name: Phone Number: Date of Birth: Please list current and three years previous addresses: Address: Address: Address: Address: Address: Highest grade level completed: If so, list here: Please list your current employer and any places you have been employed for the past three years: Employer Name: Employer Address: Employer Phone Number:   Employer Name: Employer Address: Employer Phone Number:   Employer Name: Employer Address: Employer Phone Number:     Employer Name: Employer Address: Employer Phone Number:   Employer Name: Employer Address: Employer Phone Number:   Please explain your past work experience (equipment operated, ect.):

				PO Box 126 • 2919 Hwy 200 • Hurdsfield, ND 58451 Phone: 701-962-3300 • Fax: 701-962-3303 email: farmerchad@weckerlyfarms.com