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Get and Sign Elc Pinellas 2015 Form
Dated by employer. Please understand that the ELC will contact and/or visit your employer to verify the information presented on this form. This
form should only be utilized for new employment or in rare circumstances where 6 weeks of most current/consecutive pay stubs cannot be obtained.
Additional documentation may be requested.
SECTION I – GENERAL INFORMATION: (To be completed by employer)
1. Employee Name ____________________________________ SS#______________________________
2. Employee...
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