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Please check one of the boxes below: ☐ YES, I HAVE A DISABILITY (or previously had a disability) ☐ NO, I DON’T HAVE A DISABILITY ☐ I DON’T WISH TO ANSWER _____ _____ Your Name Today’s Date Voluntary Self-Identification of Disability. Form CC-305. OMB Control Number 1250-0005 Expires 1/31/2020. Page 2 of 2. Reasonable Accommodation ... ................
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