ScHEDULE ForM
DEPARTMENT OF LABOR AND INDUSTRY
COMMONWEALTH OF PENNSYLVANIA
Sex. .....
Establishment No....... Scheduled weekly hours...... Shift......
Name
or
a0.
Actual earnings
Two |
weeks or
Depart- semi- i
ment ‘monthly
Weekly
Actual! hours
Two
#eeks or
semi-
nonthly
Weekly
Hours
over-
-ime
Hours Btatus
under- | of
time hours
Annual
sarnings
1627