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Supervisor Signature Date Title List the computer software programs that you have knowledge/skill: List any special skills or knowledge that you possess that will transfer to this position: List any education or specialized training that you have received that is transferable to the position you are applying for: List any awards or special achievements that you have received: List any business related organizations which you belong to: Are you physically able to perform the duties of the job for which you are applying YES NO If not, would you be able to do the job with a reasonable accommodation YES NO What would the accommodation (s): State any additional information you feel may be helpful to us in considering your transfer:
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