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Email
*
Your email
First and Last Name/ Nombre y Apellido
*
Your answer
Date of Birth/Fecha de Nacimiento (Mes,Día,Año)
*
MM
/
DD
/
YYYY
Last 4 of your Social Security number/Ultimos 4 digitos del Seguro Social
*
Your answer
Phone number (xxx) xxx-xxxx/Número de Teléfono
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Your answer
What would you like to tell us about? ¿Que quieres informarnos?
I got a job! Tengo un trabajo nuevo
I was promoted at work! Me promovieron en mi trabajo
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Name of Employer/ Company (Nombre de la compañia)
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Your answer
Job Title (Título)
*
Your answer
When did you start? Fecha en que comenzastes a trabajar. (Mes/día/año)
*
MM
/
DD
/
YYYY
Employment Status /Tipo de trabajo
*
Full Time (Permanent)
Full Time (Temporary / Seasonal)
Part Time (Permanent)
Part Time (Temporary / Seasonal)
Benefits
Yes ( Retirement, Health Insurance, etc.)
No
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Hourly Wages / Salario por hora (example $10.00)
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Your answer
Average hours per week/ Número de horas por semana. (example 25, etc.)
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Your answer
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