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| What is your employment status? |
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| If employed, what is the location of your workplace? |
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| What is the location of your residence? |
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| How long have you been employed at this location? |
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| What is your employment status? (Select all that apply) |
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| Please specify the shifts you work? (Select all that apply) |
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| What are the start and end times on each shift(s) you work?
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