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Format: (000) 000-0000.
- Race / ethnicity
- Date of birth*
- Do you need Spanish interpretation?*
- Do you identify as a person with a disability?
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- What is your business structure?
- Which industries best describe your business? (Select all that apply)*
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- Which best describe your food business? (Select all that apply)
- Which best describe your construction or trades work? (Select all that apply)
- Which best describe your retail or consumer goods business? (Select all that apply)
- Which best describe your professional services? (Select all that apply)
- Which best describe your health, wellness, or beauty business? (Select all that apply)
- Which best describe your arts, design, or media work? (Select all that apply)
- Which best describe your technology or marketing work? (Select all that apply)
- Which best describe your transportation, delivery, or auto business? (Select all that apply)
- What type of work or business do you primarily provide?*
- What type of food business do you operate?*
- What type of cuisine or food do you primarily offer?
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- Is your business address the same as your home address?*
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- Number of employees, including yourself*
- Are any of your employees family members?
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- Should be Empty: