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Present Employee bquiry <br />1. Date employment began <br />2. Occupation <br />3. Present rate of pay is $. <br />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.), 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 <br />Telephone No., <br />Signature Date <br />Title <br />The Fair Housing Act Prohibits Discrimination in the Sale, Rental or Financing of Housing on the basis of <br />Religion, Sex, Handicap, Familial Status or National Origin. Federal law also prohibits discrimination on <br />the basis of age. Complaints of Discrimination may be forwarded to the Administrator; FmHA, USDA <br />Washington D. C. 20250 <br />DOC 202 <br />