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["专职人民调解员个人申请表"]
["姓名"," ","性别"," ","出生年月"," "]
["籍贯"," ","民族"," ","政治面貌"," "]
["学历及专业"," ",null,null,"健康状况"," "]
["地址"," ",null,null,"手机号码"," "]
["个人简历"," "]
["家庭成员\n及主要社会关系"," "]
["本人承诺","    本人承诺以上所填写信息属实，如有虚假愿意承担由此带来的一切法律后果。\n\n                                  签名：\n                                   年    月     日"]

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["家庭成员及主要"]

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