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Get Onslow County Partnership For Children Form

Onslow County Partnership for Children 900 Dennis Drive Jacksonville NC 28546 Phone 910-938-0336 Fax 910-938-0068 www. Please enter available hours if they vary from the employee s normal schedule. It is very important that you give the days and hours worked per week the number of weekends per month the rate of pay and how often the employee is paid. Please sign date and return to the employee or you may fax it directly to the Onslow County Partnership for Children. This information will be used to set up the client s hours of care and determine the fee to the provider. onslowkids. org WORK HOURS FORM Dear Employer has applied for child care services from our agency. In order to determine how much child care is needed we need you to provide us with some information Please fill out this form in its entirety. Be sure to list the employee s normal work schedule. Use the earliest and latest time expected to work. Thank you for your cooperation* TO BE COMPLETED BY YOUR EMPLOYER Name of Business Date Employment Began/Resumed Normal Work Schedule Monday Tuesday Wednesday Thursday Friday Saturday Sunday Hours Available to Work if Varies Please answer the following questions How many days and hours worked per week How many weekends worked per month What is the rate of hourly pay to include tips and commission How often paid weekly bi-weekly monthly semi-monthly Signature of Employer Date Title Phone Number Please Print Name Please return to Child Care Resource Referral Fax Number 910 938-0068 Revised 5. onslowkids. org WORK HOURS FORM Dear Employer has applied for child care services from our agency. In order to determine how much child care is needed we need you to provide us with some information Please fill out this form in its entirety. Be sure to list the employee s normal work schedule. Use the earliest and latest time expected to work.

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