Employee Data Sheet - D.a.townley & Associates
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1#160-4400 Dominion Street
Burnaby, BC V5G 4G3
Telephone: (604) 299-7482
Toll Free: (800) 663-1356
Facsimile: (604) 299-8136
Employee Data Sheet
Name of Employer and Contact Person:
Are any eligible employees presently disabled? If yes, please provide detail – use reverse if necessary.
Yes
No
C
DATE OF
S
L
MARITAL
BIRTH
DATE OF
EMPLOYEE
E
OCCUPATION
SALARY
A
STATUS
HIRE
X
S
S/C/F
M
Y
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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25
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Parent category: Business