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Additional Information
Do you have daily access
to a computer?:
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--Select Yes or No
Yes
No
Are you currently employed or have you ever been employed by a healthcare organization?
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If yes
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(what? / when?)
Have you ever been convicted
of a felony?
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(what? / when?)
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Optional Information
(Some "special projects" require shoppers who fill certain criteria, e.g., age, certain medical conditions. If you would like us to consider you for these "special projects", please provide the information below.)
Age
Gender
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Medical Conditions
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