Employment Information Form

Full Name(required)

Email Address(required)

Phone Number(required)

Name of the Company you work(ed) for?(required)

Dates of Employment (eg. 2016-2017)(required)

Method(s) of Compensation (eg. $18/hour, $40,000 salary)(required)

Average hours worked per week (eg. 40, 50, 60)(required)

Any Additional Information?

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