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Session Date
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First Name
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Middle Name
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Last Name
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Email
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Street Address
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Apt/Suite
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City
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State
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Zip Code
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Day Phone
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Evening Phone
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Cell Phone
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Date of Birth
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Social Security #
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Do you have a high school diploma or GED?
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What institution or school is it from?
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What years did you attend?
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Have you attended college or any post-secondary school?
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What institution or school is it from?
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What years did you attend?
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Employment Status
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Employer Name
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Supervisor/Contact Person
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Employer Address
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Employer Phone
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Job Title
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Years in Position
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Previous Employer Name
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Previous Supervisor/Contact Person
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Previous Employer Address
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Previous Employer Phone
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Previous Employer Job Title
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Previous Employer Years
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Gender
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Ethnic Origin
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Citizenship
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How did you hear about us?
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| Terms and Conditions |
Summit Academy OIC adheres to the principle that all persons regardless of race, color, creed, religion, national origin, sex, disability, sexual orientation, marital status or status with regard to public assistance have equal opportunity and access to admissions, employment, facilities and all programs and activities of the school.
I understand that I must submit all materials required for admission to Summit Academy OIC PRIOR to admittance.
I hereby certify that the information on this application is accurate and complete to the best of my knowledge. I understand that I must update data on this application if circumstances change the accuracy of the previously provided information.
By checking the box below and submitting this application, I agree to abide by and be subject to Summit Academy's rules, regulations and disciplinary code. |
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Signature
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