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-esent Employee Inauiry <br />Date employment began <br />. Occupation, <br />Present rate of pay is $ Per <br />Average regular (a) hours worked per day (b) hours worked per week <br />Average overtime (a) hours worked per day (b) rate per overtime <br />Other estimated income (tips, meals, etc.), if any $ per week. <br />Expected average number of hours to be worked per week during the next twelve <br />months <br />'irm Name <br />Telephone No. <br />ignature Date <br />itle <br />ie Fair Housing Act Prohibits Discrimination in the Sale, Rental or Financing of Housing on the basis of <br />:ligion, Sex, Handicap, FamiliaTStatus or National Origin. Federal law also prohibits discrimination on <br />to basis of age. Complaints of Discrimination may be forwarded to the Administrator, FmHA, USDA <br />ashington D. C. 20250 <br />DOC 202 <br />