CS-9 REV. 6/09
DATES EMPLOYED:
D. EMPLOYER NAME & ADDRESS:
FROM: _____________
_______________________________________________________________
TO: ________________
SUPERVISOR’S TITLE:
TOTAL TIME IN POSITION
YOUR POSITION TITLE:
__________ YEARS
DUTIES_______________________________________________________________________________________
__________ MONTHS
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
# of hours per week _______
______________________________________________________________________________________________
______________________________________________________________________________________________
ANNUAL SALARY:
______________________________________________________________________________________________
$________________________
______________________________________________________________________________________________
NUMBER AND TYPES OF EMPLOYEES SUPERVISED: ____________________________________________________________________
_____________________________________________________________________FOR HOW LONG? ________________________________
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→
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DATES EMPLOYED:
E. EMPLOYER NAME & ADDRESS:______________________________________________________________
FROM: _____________
TO: ________________
SUPERVISOR’S TITLE:
TOTAL TIME IN POSITION
YOUR POSITION TITLE:
__________ YEARS
DUTIES_______________________________________________________________________________________
__________ MONTHS
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
# of hours per week _______
______________________________________________________________________________________________
______________________________________________________________________________________________
ANNUAL SALARY:
______________________________________________________________________________________________
$________________________
______________________________________________________________________________________________
NUMBER AND TYPES OF EMPLOYEES SUPERVISED: ____________________________________________________________________
______________________________________________________________________FOR HOW LONG? ________________________________