Carol Stream Fire Protection District Preference Point Claim Form And Affidavit Page 3

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STATE OF ILLINOIS
)
) SS
COUNTY OF
)
CANDIDATE'S AFFIDAVIT
I,
, being first duly sworn on oath, state
Name of Candidate
that the information set forth in my Carol Stream Fire Protection District Preference Point Claim
Form is true and correct. I understand that any misrepresentation, falsification, or material omission
may result in my application no longer being considered by the District, removal from the hiring list,
and/or dismissal from the District.
Candidate's Signature
Subscribed and Sworn to before me
this _____ day of _______________, 20____.
Notary Public
For District Use Only
Date Preliminary Eligibility List was posted:
Date of Submission of Claim Form:
Received by:

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