If Yes, please specify your driver's license number:
Do you have your own car? * YesNo
Do you have any handicaps? * YesNo
If Yes, please specify:
Do you suffer from chronic illness? * YesNo
If Yes, please specify:
Have you ever been fired by any of your previous employers? * YesNo
If Yes, please specify:
Have you ever been penalized by criminal or civil law? * YesNo
If Yes, please specify:
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