Form Bls 3030 - Multiple Worksite Report Form Page 2

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U.I. NUMBER:
MULTIPLE WORKSITE REPORT − SEE INSTRUCTIONS ON LAST PAGE
3
BUSINESS NAME
(division, subsidiary, etc)
NUMBER OF EMPLOYEES
QUARTERLY
STREET ADDRESS
(subject to UI laws)
WAGES
(physical location)
During the Pay Period Which Includes
CITY, STATE, AND ZIP CODE
OF WORKSITE
OFFICE
the 12th of the Month
(subject to UI laws)
WORKSITE DESCRIPTION
(plant name, store number, etc)
USE
Round to the nearest dollar
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:
.00
COMMENTS:

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