A. Have you ever been employed by ACCOUNT_JOB_COMPANY or any of its subsidiary companies?

[ ]Yes [ ]No

 

If yes, please provide details

B. Do you have relatives employed by ACCOUNT_JOB_COMPANYor any of its subsidiary companies? 

[ ]Yes [ ]No

 

If yes, please provide details

 

C. Are you a United States Citizen or resident (Green Card Holder) subject to tax under the Internal Revenue laws applicable to citizens and residents in the United States? 

[ ]Yes [ ]No

 

If yes, please provide a social security number: If you have canceled your Green Card previously, please provide supporting documents.

 

D. Are you in the process or have you ever been declared bankrupt?