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Human Services, Department of DHS Iowa Gov  Form

Human Services, Department of DHS Iowa Gov Form

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Estimate of ongoing wages Pay received or expected from to Projected hours/week Rate of Pay/Hour Tips, if received $ per month Salary, if not paid hourly $ per Bonus and/or Commission $ per Is this a good indication of future earnings? (circle one) Yes No If no, please explain: $ per Is health insurance available? (circle one) Yes No Type of Pay Pay Period End Date Date Pay Received Gross Pay Hours Worked Regular Overtime Weekend/Shift Differential How often...
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