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Get Williams College Employee Accident Reporting Form - Hr Williams

E (MM/DD/YY): 8. Date of Birth (MM/DD/YY): Y / / / / E 11. Piece or Hourly Worker? 12. Hours Worked Per Day E Hourly 2. Home Telephone 3. Department 5. Marital Status Single Married 9. Sex Male Female 13. Days Worked Per Week 6. No. of Dependents 10. Hourly Wage $ 14. Avg. 52-Week Wage: $ Estimated or Actual E M P L O Y E R 15. Employer Name 16. Employer Self-Insured? 17. Federal Tax ID Williams College Yes No 04-2104847 18. Employer Address (No. & Street, City, State, Zip Code) 19. Emplo.

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