*0116100W061502*
01-161
PRINT FORM
RESET FORM
*0116100W061502*
(Rev.6-15/2)
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Qualifying Data Center or Qualifying Large Data
Center Project Job Creation Report - Supplement
Page _______ of _______
Qualifying Data Center name
Qualifying Data Center registration number
Provide all requested information for each qualifying job
(See instructions on Form 01-160. Attach additional pages as necessary.)
Job number
Position title
Job _______ of _______ total jobs
Employee name
Employer name
Physical address of employment position location (Street number and name, city, ZIP code and county)
same as data center
Employee begin date
Employee end date (if known)
Annual wages/salary
Job number
Position title
Job _______ of _______ total jobs
Employee name
Employer name
Physical address of employment position location (Street number and name, city, ZIP code and county)
same as data center
Employee begin date
Employee end date (if known)
Annual wages/salary
Job number
Position title
Job _______ of _______ total jobs
Employee name
Employer name
Physical address of employment position location (Street number and name, city, ZIP code and county)
same as data center
Employee begin date
Employee end date (if known)
Annual wages/salary
Job number
Position title
Job _______ of _______ total jobs
Employee name
Employer name
Physical address of employment position location (Street number and name, city, ZIP code and county)
same as data center
Employee begin date
Employee end date (if known)
Annual wages/salary
Job number
Position title
Job _______ of _______ total jobs
Employee name
Employer name
Physical address of employment position location (Street number and name, city, ZIP code and county)
same as data center
Employee begin date
Employee end date (if known)
Annual wages/salary
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information
we have on file about you. Contact us at the address or numbers listed on this form.
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