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Print this work sheet and fax to Factory Direct 515-262-3095 Information Data Name Phone # e-mail city street state/country/ (include zip) Fax # Truck Info Truck Make Truck Model Truck Year Gas ?

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Employers are required to file print this worksheet for their employees.

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The purpose of print this worksheet is to track and report employee work hours, wages, and other relevant information.

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Information such as employee name, hours worked, wages earned, and any overtime pay must be reported on print this worksheet.

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