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["遵义市零就业家庭认定表"]
["申请人    姓名",null,null,"性别",null,"文化程度"]
["身份证号",null,null,"年龄",null,"就业创业证编号"]
["户籍所在地",{"$nulls":4},"联系电话"]
["常住地址"]
["家         庭        成         员        情        况","姓名","与申请人关系","姓别","年龄","就业创业证编号","是否有劳动能力",null,"学校/服役 /服刑"]
[]
[]
[]
["社区意见","            （盖章 ）\n         年   月   日",null,null,"街道（乡、镇）意见\n  ","              （盖章）\n             年   月   日"]
[]
["县级人力资源和社会保障部门意见","                                                        （盖章）\n                                                      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。"]