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Hours worked per week: ____ Mon ____ am ______pm Tues ____ am _____ pm Wed ____ am _____ pm Thur ____ am _____ pm Fri _____ am ______pm Salary information: Income Rate: $ ____________________ Frequency of pay:  FORMCHECKBOX  Hourly rate:  FORMCHECKBOX  Weekly rate:  FORMCHECKBOX Bi-weekly rate  FORMCHECKBOX Semi-monthly (every other week) (twice a month) *Does the employee receive any other form of payment (overtime, bonus, commission, incentive, tips, etc)?  FORMCHECKBOX  yes  FORMCHECKBOX  no If yes, what type?_______________________________________ How much? $ ______________________ How often?______________________ I understand that the above information pertains to the employees eligibility for child care benefits and is subject to verification by representatives of the Ƶ Child Development Center. Under penalty of perjury I affirm that, to the best of my knowledge, the above information is true and correct. ________________________________________ Print Authorized Employer Representative Name ________________________________________ _______________ Authorized Employer Representative Signature Date _________________________________________ _______________ Employee Signature Date     Ƶ Child Development Center 900 Rancho San Diego Parkway, El Cajon, CA 92019 619.660.4660 Fax 619.660.4603 R p q < A S U V W \ ] i j m w x ƾڣڣ⟣⏋{shk-h35h3CJaJhQCJaJhQh>[hQ5hh35hA hk- hk-5 hk-6h3h36 h35h>[h35ht"h3CJaJht"h3CJhhh3h35CJ\hx37h-~fjh+U-ij Q R j A ^ 2 gda dgdk-gd3dgdFmgdFmgd3$a$gd+    , B U V W e f g x y I M O [ ^ _ 񓏄jMha Uha jha Uh3h35aJj hQUje hQUj hQUjhQUj} hKhUjhUhh- hQhRVh3ht"h3CJaJ0 2 7 V Z v w x ACD](5:Z\$()*Iq "#%&(䱦䦱h"jh"Uhg0h=?uCJaJhPh=?uh=?uCJaJh=?uh3CJaJh=?uhhFmhk-hk-5hk-h35hk-h5h- h3ha jha Ujha U22 w x CD\])*!"$%'($ L*$1$]L^a$gde@"gd(gd=?ugd3`gda gda (QRh¾hg0h"he@"hYCJOJQJ^Jhghe@"CJOJQJ^Jhghe@"CJOJQJ^JhYCJOJQJ^J gd(gde@"6&P1:pe@"/ =!"#$% } Dd | T r<  C A2 +ԯ+b D3`! +ԯ+b` x pT{oAA@Q#&1*DAQ( 8QTLeP@%*4R"Xj$#6UP@ʇT(d b܁ #peѮô13{ι.a-vc:0民Ё'@C;sezpj,+-a$f-%Ǿ}`7YXgh^|7w+Ujۋi7;8~N?Ot!hgbϩ :8{/mn.jUj{SVmךlrRl]lٟS6XFrT'CM'tJ>Vc;H;Դ>۳⭱'_<3 {.μ^JT0nߖfwj۷yTPC 8'8nefߥyF1̙Üm18'%g>^PʟΧ56c`:,`6[ w zb=/G3('۴e?nYW/_ e~ ם<#y3 εٯˑSgsY:Ẏ@Q^0k?rI:ve}s[9x+ f֒~4:l'L'`Yb(+`sD.: =q {c>] a=D 5\qYg+vPW*cef6yaY$y":%l)qȱf\gE+z= 22)f8VlUu{41dHh$wUȋ4!kc4q>72 G[\$aܫ7u>[̋$,rx7:,=TE=;DNj%a)k1)Uԣ$ >l&#׉\k{ HX@-$&l{Ÿd&Ϥ)%xpE) WIX8o)DWn8CrюER.rn7B}2u n'a )_AwQHRfl˕le56\|Dz)2&EBy]JMr-WgQW&?esd3@,xus$y\:GWU!_ȵ|5K~nM_Zc0u`= 2J 뱾*8ӷL~.KV5='v x{UbOwBKY޳W^ž^ }rh.lHEr*ɓHX#er"U2 ܓm!6eoȓ$,o er8"sKI\G)2Q wdDF ֌02)HI?v8Mg̗elS*qSkYɁ )Bl\-r_+sN9.Aɲ):sdS!:a$#!%$wJL^t/I!6峤"d.91Q5#,+H|T SITu!bZOe54A$FRssITHَ{8ӧŸmZ#!ϳZjR??<T"6b٦9umDDޏɿ-1_g:ݎь 6<=;FK|=h7ZgKqҨ7_J_"Ć5#\cjzlI/17)AlxMRwuЯX3oVhZµu 6<]F^Hv蕤A#X3|h ;KI~>fח_CDO!=4vlз#wj#XxzWG1R"knRŎQ/%ku&B4INDJvБI/8q="z:b/&ӊz)r7v `}$BR?ww=^yL6b4oN{[OpWD:3~$}w`cz0g鱐O!c$E!F""6pѠF#֌!UgMR72M49#5WcyRQ׌cHmڅU3#6&0 u;7\o%a"tDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5tDeCheck6!s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH D`D NormalCJOJQJ_HmH sH tH D@D  Heading 1$$@&a$ 56CJ$DD  Heading 2$$@&a$ 56CJ LL ? 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