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Date
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What type of vehicle will be used under contract
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SUV
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other
What year is the vehicle that will be used under contract?
How many moving violations and at fault accidents have you had in the past 3 years?
Do you have the legal right to work in the United States?
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Yes
No
Have you had a DUI in the past 10 years?
Yes / No
Yes
No
Are you fluent in the English language?
Yes / No
Yes
No
Are you Drug Free?
Yes / No
Yes
No
Can you lift between 25 and 75 lbs?
Yes / No
Yes
No
Is the vehicle that will be used under contract registered in your name?
Yes / No
Yes
No
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