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Jubilee Homes Build to Work Assessment Work Rides
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* Indicates required question
Email
*
Your email
First and Last Name
*
Your answer
Date Of Birth
*
MM
/
DD
/
YYYY
Address ( Including City State Zip Code)
*
Your answer
Phone Number (area code) 7 digit phone number
*
Your answer
Head of Household
*
0 points
Yes
No
Required
Female Head of Household
*
Yes
No
How many people in your household
*
Your answer
Where do you work? (Name and complete address of Employer)
*
1 point
Your answer
What time or shift do you work?
*
1 point
7am -3pm
Weekend
11pm -7am
3pm -11 pm
Weekdays
On-Call
Other:
Required
Do you need a round trip or single trip ride?
*
Round Trip
Single Trip
Pick Up Location Preference
*
Price Rite South Ave
Bus Hub Downtown
Price Rite East Side
Other:
Have you served in the military??
*
Yes
No
Required
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