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Birth Date

Emp Phone 1

Emp Phone 2

Emp Address 1

Emp Address 2

Emp Address 3

Emp City

Emp State

Emp Zip

Employee ID

First Name

Last Name

Middle Initial

Social Security Number

Pay Class Date

Pay Type Date

Rate

Rate Date

Hire Date

Hourly Status

Hourly Status Date

Status Date

Status Type

Terminated