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Total Years of Fire Service



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Personal Information

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Name:

Lina Angel

Date of Birth:

Gender:

Female

Race:

Hispanic or Latino

Height:

5' 8"

Weight:

132

Health Information

Update

Do you now use tobacco:

Yes, Regularly

What type of tobacco:

Do you now take prescription medications:

Yes

Your current prescription medications:

Drospirenone

Have you ever been diagnosed with cancer?

Yes

Cancer type(s):

Employment Information

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Agency:

Agency FDID:

Job Title:

Employee ID:

Agency Start Date:

September 2011

Agency Headquarters Address:

Station #:

Station Address:

Shift Cycle:

Shift:

Date Joined Fire Service:

Total years of Fire Service:

Do you have another job:

Yes

Days in a month you work at another job:

Contact Information

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Are you willing to be contacted?

Yes

Contact Phone:

Contact Email:

Contact Address:

Preferred Contact Method: