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Present Employee Inquiry <br />L. Date employment began <br />2. Occupation, <br />3. Present rate of pay is $ Per <br />4. Average regular (a) hours worked per day (b) hours worked per week <br />5. Average overtime (a) hours worked per day_(b) rate per overtime <br />6. Other estimated income (tips, meals, etc -I if any $ <br />per Week. <br />7. Expected average number of hours. to be worked per week during the next twelve <br />months <br />Firm Name Telephone No. <br />Signature Date <br />Title <br />Ile Fair Housing Act Probibits Discrimination in the W Rental or Financing of Housing an the basis of <br />Religion, Sex, Handicap, Familial Status or National CdghL Federal law also prohibits dismindnation on <br />the basis of age. Complaints of Discrinflnefion may be forwarded to die Adadnistzator, FmH& USDA <br />Washington D. C. 20250 <br />DOC 202 <br />