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Incumbent Worker Training Program - Customized Training
User: SampleUser TP: LWC Sample Training Co.
Empr: Sample C.E. Test Co. Application #: Sample

CONSORTIUM MEMBER MAINTENANCE

  Federal Tax ID #
U.I. Account #
 Name of Employer 
 Mailing Address   Street Address  #
of
 Emps 
 Name of Contact 
Job Title
Phone / Fax 
 Email Address 
Website
Edit Del  
 [909090909]
 [90909]
 [Sample C.E. Test Co.] 
 [PO Box 1234] 
 [Baton Rouge, LA 70804] 
 [1234 Sample Ave.] 
 [Baton Rouge, LA 70801] 
 85   [Sample E.M. Ployer] 
 [Owner] 
 [ 225-123-4567 / 225-765-4321] 
 Sample@Employers.com 
www.LaWorks.net
   Edit record.     P    Updated by SampleUser on
11/01/2004 12:00:00 PM

 

Federal Tax ID #:
U.I. Account #:

Federal Tax ID #:
U.I. Account #:
Employer Name:
Business Mailing Address:
Zip:
City:
State:  
Click here if the street address is the same as the mailing address.
Business Street Address:
Zip:
City:
State:  
# of Employees:
  Contact Information
Name:
Job Title:
Telephone Number:  format: xxx-xxx-xxxx
Fax Number:  format: xxx-xxx-xxxx
Email Address:
Website:

     
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