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Get 2012 May New Employee Eligibility Documentation Form

Pear on at least two weeks of payroll records. Then return this form to your Kaiser Permanente sales representative or your broker. COMPANY Information Company name Customer ID (if assigned) Employee Information Employee name Start date Total hours worked each week Hourly wage Social Security number (last four digits) signature By signing this form, I attest that the employees listed above are permanent eligible employees working at least 20 hours per week. I understand that this informa.

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