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Get CT Payroll Certification for Covered Service Worker Contracts 2004

Y to the contracting state agent upon request. WEEKLY PAYROLL REQUIRED EMPLOYER/CONTRACTOR NAME AND ADDRESS: PAYROLL NUMBER WEEK-ENDING DATE EMPLOYEE NAME AND ADDRESS Connecticut Department of Labor Wage and Workplace Standards Division 200 Folly Brook Blvd. Wethersfield, CT 06109 TERM OF CONTRACT: CONTRACTING STATE AGENT/STATE AGENCY: CONTRACT DESCRIPTION AND BID NUMBER: MALE/ FEMALE AND RACE* WORK CLASSIFICATION TRADE LICENSES TYPE & NUMBER S M DAY AND DATE T W TH F HOURS WORKE.

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