Employee Name - First Last   

Employee Address   

Employee Address - Line Two   

Employee City   

Other Info   

Employee SS   

Employee Dependents   

Employee State   

Employee Zip   

Employee T   

Employee Za   

Employee Number   

Employee Position / Class   

Employee Date Hired   

Employee Department   

Employee Pay Grade   

Employee Birth Date   

Employee Var   

Employee Skill    

Employee Skill Level   

Employee X2   

Employee X3a