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["遵义市就业困难人员认定表"]
["姓    名",null,"性   别","            ",{"$nulls":3},"照   片"]
["婚姻状况",null,"身份证号"]
["政治面貌",null,"就业创业证编号"]
["户籍所在地",null,null,"家庭居住地"]
["登记失业时间",null,"失业原因",null,null,"联系电话"]
["就业困难类型","  □4050","  □低保家庭",null,"□残 疾 人 ",null,"  □长期失业人员   "]
[null," □失地退捕","□困难高校毕业生",null,"  □零就业家庭   ",null,"   □其 他  "]
["家庭成员情况"]
["姓   名","与申请人关系","年  龄","工作单位或学校","是否登记失业人员","月收入","备  注"]
[]
[]
[]
["本人承诺：以上所填信息均为本人真实、有效信息，如有虚假，后果自负。                                                                                                                                    "]
["                             申请人："]
["                                                                 年    月    日"]
["社区意见","           （盖章 ）",null,"街道（乡、镇）人社中心意见\n  ","             （盖章 ）"]
[null,"         年   月   日",{"$nulls":3},"     年   月   日"]
["县（市、区）人力资源和社会保障部门意见","                                             （盖章）     "]
[null,"                                               年   月   日"]
["说明：此表一式3份，县（市、区）、街道（乡、镇）公共就业服务机构和申请人各一份。"]