LIST OF AFFECTED WORKERS

Names of Affected
Workers

Contact Address

Sex

Age

Educational
Attainment

Occupation/Skills

Salary

1._______________________ ______________________ ____ _____ ______________________ _________________ ___________

2._______________________ ______________________ ____ _____ ______________________ _________________ ___________
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15.______________________ ______________________ ____ _____ ______________________ _________________ ___________
I hereby certify that the information is substantially accurate.
Signature____________________________________
Printed Name________________________________
Position______________________________________

Telephone Numbers_______________________
Date______________________________________