|
Exhibit G
<br />Semi -Annual Job Creation & Hiring Report Form
<br />City of Lakewood CDBG Economic Development Loan Program
<br />Semi -Annual Job Creation & Hiring Report
<br />BusinessName,
<br />Prepared
<br />.
<br />1 Job 1/ /
<br />Job i f 1.
<br />Job/Position Data
<br />Applicant
<br />&Actual Beneficiary
<br />Data
<br />Job Category, Job
<br />Title & Employee Names
<br />�
<br />• ' • • r ��•i Zi
<br />EMO■M
<br />�
<br />r"`r f.�
<br />� rfiy��-��#".�..���°f{
<br />�"�FeY .�
<br />.� {f {✓}
<br />: ,
<br />� Y f
<br />d. � �
<br />fr ✓ ,!r~}
<br />� . Y�� ��
<br />,'`!" fi .>
<br />�#;-{},
<br />.� r�{Y
<br />!,'� � �r
<br />� � ' ,�
<br />Y {s
<br />-rr �'�
<br />�`
<br />- Y�-
<br /><%`�f
<br />� #r'fr�}�`#�
<br />,�
<br />rf.£
<br />i
<br />p'° e
<br />�✓f�f.�
<br />�i° ✓{'�fa }��`4drYm�
<br />� ..
<br />rf ✓�/��1
<br />f�{Y�.'r'..}'"}l
<br />r .., . .•sf��. „ �. � # °�
<br />#f}{r�s�'..f*'{f .:��.
<br />f
<br />s",!'.,::s
<br />,r}"r;�.f".
<br />r�.✓r'
<br />fi,.'
<br />�>:
<br />e'sddF sfr.-
<br />,° J: f;{.`:r
<br />�,
<br />.lr afrt.✓
<br />t
<br />r"s`v'^i�
<br />rv`..: x`�f r�..
<br />✓rl#�ff:•asffs#f�#�r-ifi�
<br />..s'l
<br />..,...
<br />,�'
<br />'/' :"/ { i
<br />✓f fi{ir.i���>�Y
<br />1�t�8'
<br />frtd
<br />fi`1
<br />rr+i���zi�.°f�r;�vi
<br />:r".:'..-'.'v'.',"i'
<br />,##
<br />/
<br />�ax�f{f'"f{`.°�.n`'.�"r'
<br />'r'.!x',?�OrfP�fir°a{�
<br />%✓if�':#�r.�rt
<br />`F �.}xrrl}'fi:.lf'�
<br />,f1�d`i:'1'f.�`'r"�a'��,��,�r,",.
<br />Employee 2
<br />:fi°! e' d{*#,.r ;?^✓:r:'
<br />r"fri .,'s"�:�x}�,'
<br />r%�'`r`f�l�r
<br />1 1
<br />+"'°'rx`rd'`r'✓'f5P`'}ffff,il".
<br />e� rf✓ rr�'✓
<br />f}��Y f�!#� Via`
<br />{� arm }:��fff,r>f``.
<br />.''fi'{er''■�
<br />IIIIII-■■■■■■■■■
<br />I�•• .
<br />• • •
<br />■
<br />'r*.
<br />■
<br />� ,
<br />f.!
<br />�s ' �'i`.+`✓'s
<br />'"p�.�"3
<br />l'e°l.
<br />�.�a s'�{t!{
<br />y''PF"
<br />rsx,r"/
<br />aa'ar �'f3`r'. %
<br />Y�/«z F° sfJn.
<br />f�"f' r' ,±�,l.''
<br />r. x`v°;;�.+',.Y.<'.x"Y"'ft.
<br />Ji`>° ,-P°fi'
<br />�rix f"'dfr
<br />�`...
<br />1`.""' C
<br />x",��',d' r"rr ' ^" .+'
<br />f✓'✓.ifJY f.r`Y
<br />}+�'P' I' ✓'. x'`'.✓
<br />i`� l". fIr°« t".�:`
<br />l�Y.!"
<br />r'li s}'.rx�.'{r#`f.d'r'`
<br />«fi„ f '..
<br />J'
<br />f#r fe`
<br />.+` r`
<br />#'%+' ,bi9'',. 'd'
<br />�
<br />/ f.{f�,lFT
<br />Bd`}r" }}✓�.:�sx�s'a°`...
<br />!dr' }�✓�ff"Oe�.•'tfd`
<br />�
<br />1f�`Y�f.G.%.di
<br />dr,sFr`:""/Br":.%'1,..°`,#',.'%r'"ra""`{.'#°}
<br />�
<br />d: F.r'd
<br />.#
<br />-°P:°.. e'
<br />1`.;a`ip'"l
<br />,., fix
<br />i�rrr{«
<br />J'� r^`fr
<br />F�% f
<br />r
<br />x «
<br />,✓r'+
<br />F,,.^'�e'1yi
<br />1 1
<br />p P r'!.
<br />.:^'f �'{ s}"{ l'✓.'
<br />�. .r"fir'r' #Y.. r
<br />f !` .. l{�"f�..ffFxr✓
<br />..
<br />��f $.,✓f�rr.f
<br />-rY r�°� ..#f�-
<br />F d��{//r'1'.r'Ffi r"rFrvJa°{F'fl
<br />r"-'s}` f'f ,>`..
<br />rT .± .'r%fr" fl
<br />.�:
<br />�.YrI.
<br />.� �
<br />✓Y�aif�
<br />Y�t✓�
<br />J{.. r` r°.✓,+'.1.: <r'.+�,s'd'.TJ{,'�F`�,
<br />� . }.. :�i' ,�, s.
<br />!`l:�.?".f.'! 1r�. i,✓.'°f. z� ,'"
<br />f,"s'f..d ar'''fi.„;',
<br />.£ ;'� 1`.;""i'{r'!!'s'',1'�sr ✓°�
<br />r.f". �.% . #'a ',s'..,
<br />r �"}eY r�" .f�"�{#r.,�l r!"lr`r°{`
<br />.},
<br />: ,"':. ,"*
<br />...#. f,--
<br />l l"}"r
<br />Y
<br />lf;`
<br />r":.:°r,"z
<br />,..
<br />iv'..9'fr`I"r' d'
<br />f ,r rr!�"�Y
<br />r'1 ,.
<br />r„... 1}�.
<br />"s"�id
<br />,.•°}dY.". ,'f i°
<br />r
<br />v..
<br />,°1,e
<br />f"d'.'.,#.?Y,d.'.
<br />.
<br />r+� �
<br />ax" :E
<br />r' :.��f. !d
<br />r'f }fi!�
<br />J'"..' F'a'`.%"r'%..,A°r'?P✓f`,.�sl.�'l
<br />-r..
<br />f �� Y ,� �#?
<br />r':4"{d`,^"/}'d"°�i'r�;+'f
<br />f f�F��%�.:
<br />" `
<br />�f`,v�
<br />qi...
<br />.r.,:.-.r
<br />r
<br />�f F}��.#
<br />rr.+.i'.. ,s
<br />r5r-�':. a�.,'.f�i'
<br />r.
<br />r'.o'i't's.'{���r`J`
<br />f��x/`
<br />r r�, Y #",*�`f
<br />Cr".:,� f
<br />�.
<br />o`. rr/l.
<br />��,t,�.��ff
<br />.f�F..r�T.rlfl%;°rtf",
<br />/' il'f..�`,�.
<br />-....,,�
<br />x/✓s'.'iie.;
<br />axe.#
<br />ft"
<br />r.
<br />'"�
<br />.�:r�
<br />!"
<br />�"r`�r
<br />J _r-..
<br />d*l:.:r}
<br />;�
<br />oTd"s`.
<br />f;
<br />r.� p .
<br />1 1
<br />%°e{,f f i`�
<br />r'•sbx�.✓".+�1'
<br />:�'#`r�fYf� ""llY,f`"°'x'r
<br />''r .�',
<br />r'" .f d ,+"f
<br />�,°#.rfr's`��e`'.�'�{e
<br />.Pis�{tFl�.*"'1'J l".ta'.r' J+'P�s°r�!'f ✓
<br />YffT !fi'{�`/ s'.!' aft`/Yr.,""l e'�
<br />��Ft#'�,l.�#�'�s'�,'-"'s`�i
<br />■■■■■■■■■
<br />1 i
<br />.xi',?{i'{.!�ler
<br />�rYrrfr{}f���'';fr"rtr{a✓rf!-ffifYf`r;�i'��F';rr�•�+Y'�rrr-�Y.��®
<br />d#'��%fj✓d
<br />�`f�Yf'fif ✓.'��t'fiaf,,�t�
<br />_■■■■■■■■■
<br />1 1 i�
<br />J Pe'r'T.fff�.r'`
<br />""e` f`=* ax#'S«
<br />tt"✓.fi. F'�;a"r«f/+e Ifi/'{{.'
<br />.>'fi.!''��f�r�P,Yr}frFrl�:;''Y�
<br />f✓d !'d` PC,a"
<br />f Af f ,.�
<br />J"a"Y`f`�i i
<br />6"Pif'`.✓,!r°`F`tl�l ��."d` {
<br />✓'.` Il.+°P r l,f' 1!«" s`f dl i" ;r
<br />r i :i'fi{f{ 1'' ./"% /fiPY {J:
<br />#.::�'�"r�.■■
<br />_■■■■■■■■■
<br />f
<br />ffYe'p'!
<br />!«'
<br />Y
<br />f fY
<br />{
<br />•
<br />• • CATEGORY,
<br />■■■■
<br />, , ,
<br />s✓.
<br />%`f
<br />`'+d'l"
<br />p°i`,.Y.,+
<br />yX�r���
<br />..ffj+`d'
<br />s9'
<br />f .fi {
<br />fs'"'3f',e'f�rt{F`l,�'1°r°`!✓f".*"f
<br />+¢rr le'`tt.
<br />!`
<br />{✓i`
<br />�.. a//
<br />f:"r°
<br />/ i` .+"`r°t°n'..t'i"
<br />ff y�
<br />✓,fie'
<br />fi. ,° ,$�'✓'
<br />?` a`{{xs'..°ir'a'•.^,
<br />/F'f!.""j'. ^`fir}/' {l.+'e6{Yf.
<br />r'«rr�sr .
<br />s'✓.✓ ..^',r/J`r.1`, e'�f.,`
<br />{ J's"{s`��rrv%
<br />'f'i`a"t,
<br />'j*lf`/
<br />?f`},.✓r'#'".+'#r`!.
<br />erI'. .z.+rrf` rrd`f
<br />r' ,fjxff9Xr`
<br />r''1`J° rr ./"a'rlf
<br />>'`«fesf'r/,i°s`{.*°;✓,✓'fr"#'//:e�f+°.I`".+f}
<br />e!"1,�
<br />.f e..i{`t'«rr{a"«.r'
<br />.
<br />�f`�.
<br />+�.✓dri"Av
<br />', '/fsPs",.�`FfJ"xrJ'f.lPf
<br />r`
<br />�{`f
<br />s' .:%dt
<br />.✓t`!°�i{,��..
<br />f's'`B,'r,"f.
<br />F i
<br />r`f /.f/'F.
<br />s".a""'7.1`
<br />.%fi./"f
<br />i"
<br />x,t f .fi
<br />rr�. Fe�Ji"''eYs', rr'+x.
<br />�a !" r"Y ✓'".r.3'
<br />�}/`�.�
<br />p a
<br />,dl r°v!. {fi°/'x a'
<br />.%/"!.d.F".''r'Y.i.+"5,.:{..*r"s'v"s'i'f.�'«e'�d.+r'r
<br />:�flr#�f ���YY.#,r*#.�'#'f
<br />Y,ren :.6 e.. f ,7`!/f Y..
<br />fr /,5"�a'.�Y� :f%rd#", ,�'Js' r{�.f�r x 1` ✓,f'
<br />lP'l°.P/, r
<br />%F
<br />%J` ,A',1 f.,✓`s''.
<br />f✓ !`✓ #'.lif".fr
<br />a`fa'f:
<br />_
<br />e°��.."'
<br />e 11�9'
<br />' � t .%
<br />{ �+'�
<br />>�.,t
<br />rd.{
<br />�Pr}�/.^%�rF/✓�fll`s`�a'r/�
<br />✓'. fi". f' s''.°..
<br />,�.±i`.=�1`r
<br />'sy�t.✓
<br />1'#"`n,.✓,ff.+.
<br />rI#,{✓" a'. 1' `��
<br />.✓Yr
<br />s .+r r
<br />e^ .a rF°r
<br />,.�'lfif, sF e
<br />i1i'a'..#<9"r.+ %t
<br />,f'/�!'
<br />�.
<br />fi' 1
<br />{�<��
<br />a'fi" '
<br />��r9`: ":r"..
<br />°f ?'dfi"t".r"r".
<br />,,. >� �/{�r���
<br />/r F'Pi`%t`r
<br />.! ;F«.v.
<br />,°, s". ✓".a 1r6
<br />ff.Ff 1. f"f'f'
<br />J�:n`.:1ff%fr°:rd'..
<br />✓ p{ J' f..i'i"✓"l/'f`.e'.!`ff
<br />:�.`:E;.r" f.,;`fif."rrt
<br />r./.•G". ,F'. ` l".,'
<br />... s
<br />f /f:1` J',
<br />- .":.
<br />...
<br />ds�.t'}r'..''
<br />!`l` z`.
<br />fry^'✓Pv`,.;.t°...
<br />., .r'
<br />.r`1` Fa`
<br />r'�rY f✓ d
<br />r
<br />!'.r'"o'r'.
<br />r'fr.
<br />r': r'-3
<br />r°P` '
<br />°',✓" a:
<br />1 i
<br />,a�."•"'.d J.t`�.+r.P�f
<br />:}ys�r�'r'r�'Y`,�f�}r��r��''r'r�'rr
<br />a"r/fd r''s6.6./fPlf{r.✓�'�rY"
<br />,-":r'"�d`�
<br />1"���.r�'trf"��.'`�.!'".r
<br />`�.,#�;�.r■■
<br />'II-■■■■.■.■■
<br />1 1
<br />i'a r'Sf �.x7'lfPjr
<br />Yilrrd / ,ii1`.'f
<br />�l�t#}Y�ff�l#✓rr°*°l
<br />Y{ff ffr'r'r'/
<br />1ff 'rs.■
<br />17 � �lJ..ftrjfi'l/f f
<br />_■■■■■■■■■
<br />'�F'!yls/!`.,'Ps'f%;r".r"".
<br />P.+`.1�.!#{f +£'pl�v"r°f�P�:ffff
<br />J?I'✓�#f°fY�fr,�`r,,
<br />•• • •
<br />. •
<br />■
<br />■ ■
<br />' / e
<br />®%�
<br />r. r.:r r , f r•. r r n-€e
<br />�J°
<br />fdfi
<br />5°,n:'as F}
<br />r.F�.fi
<br />.�i✓ F`e``s`'
<br />,,?dr`.F..s".r``,f.*.s`%#"r"
<br />. rr'v" :,r},:'✓
<br />.i fr,.!,.e'r`,!
<br />;�"r*f`�.
<br />e'f'.'. :%
<br />fsF!.x+�ff..'
<br />r'{r":,J✓' r-r+``
<br />i..lYlddy�
<br />l .✓`r.�".✓ .:� /rPt'1
<br />ra'1.. 1`�.%>�r`�v
<br />�'rr°�i,�f.a1.. r�fr'f� sYrr,;
<br />lr'ii ,#,� ,r /'. r' "!' t*'I'«.t`%°'�✓
<br />f a✓fdt.%r.v lr' 1f�rw,
<br />,✓!fil'"/°vf ��..rsiff`
<br />r'.r"l-llrr'-rr':v.
<br />�^"r'
<br />rr°f`rr'}..r'.;.;+,?ifP.
<br />J`ad rr
<br />�'i° l:'v'e'
<br />� flfllflr°r^"..'
<br />r�."'r° f fi'.!`%##
<br />�'"fff'r'.fx°r` 1/fs"'l
<br />!`-.✓p�P�Ir�"
<br />l�r /rt`.i,?r}..'dri'✓
<br />t / .i t;'.^"fr�i".'..�
<br />of{R6'`r{ m,"Y"�f {,f
<br />✓f+f,-FE`..1.l1J1'a`�s''
<br />f�-r."!figr{r"O,z✓
<br />lr�' . ?`'�
<br />ffdr
<br />{
<br />v �ifrSr{P}
<br />f'ar✓`
<br />,+:°✓.`:.,,�
<br />r{ .r��tl".
<br />r"'..?
<br />".
<br />d`
<br />f
<br />d.
<br />.
<br />�y+ !:
<br />' fi�%`+✓#'.P..
<br />.^`
<br />x`/ fr`z' frfi
<br />r ^
<br />Jr .!'.Fs'
<br />,. s�-.
<br />�. f'f
<br />fn+llfr ./'
<br />_ #
<br />f r , r`t. F..r
<br />�. ... ,ee
<br />ffi" -!"r`. lr fs`•e�`..
<br />�,�
<br />f� r fY.a°Jri!"./'}.. .'a'x
<br />Ft's°�✓r".f`... s�%ef
<br />f r.. ,r xr �:✓✓
<br />.',*'/ .,.. fe r ,+'if. . r f yp
<br />x xY > 'fin
<br />r ,. .«.. a°n..1 o-'ff f"%r
<br />..rr. .� ... s
<br />.�...'rf5`y�
<br />r.+fi*��ffr'{t{fi
<br />/s"�:f/'.✓f
<br />�fi'fi`. i'✓a"`
<br />�
<br />r r'{ �}
<br />,�.ztf.-,��F
<br />.sF
<br />r"'F.`i'�ddii'✓9
<br />• nl" ..'�,/'.+
<br />.�"J.Fd"T
<br />f ..f
<br />�
<br />/': J f fr�.{
<br />: i`t'".ff .rT e""i.*"f%9".f `'r`.a'.!"J'o+�+t'�.rd'!`T
<br />r.. fi�
<br />l'+�F'..li"// J.. .fi,r
<br />t° !
<br />f. l
<br />{..*rr"-€ '.r"".:°.. %.r� �,n'"r•'
<br />�>�s�i�s+rx��1Ji''n�^axi
<br />e�
<br />✓. d./r
<br />r .
<br />l'_ nr'. ,!f".f'r
<br />✓'«f`.i
<br />/.r j.
<br />f F"f ?-t"
<br />3r.
<br />r .'�
<br />✓r"/'r'x'fif i°�?"«
<br />✓i'`�.r'�}.
<br />,!t', �. r'�{.
<br />.�`p" J
<br />i��.slr fi�r�..>"..
<br />r. r r
<br />.if � fiE
<br /><voi'B�Pv r�.,�✓.�.«"+``.<,.ssfr
<br />.k>°«*;P,+.+'� /"/a'.*'!
<br />.. v
<br />J+".: ^^{'.Y
<br />... n,."' J..
<br />✓r .^" e ..r .1`fP
<br />..*rf�_rt"rf'
<br />. ,+. r.�
<br />.#`s o-r.£/.
<br />�"F
<br />rfififi�t�>
<br />e�'P1Y`,�'rf�9',.J
<br />..r
<br />l /r..
<br />..
<br />...,prr
<br />P?{
<br />a"it°!e"'�!1�}�f.�`"�.�'arl"f
<br />n�.,+ ,rs rffi,�i.'r'.+*,i
<br />dr {��rf�
<br />l�fl"".r``P:^�'.Ir'',€l#f"
<br />..�f.+tl
<br />>f'f ✓✓f,�'f
<br />,+'+x sFf✓"s'fr
<br />rr�'rY`�f✓F{.:`{,'.%x'fir"'�a":t''rf'r J_/r`t
<br />.�.'''� z'r'r"s''.✓'f"fi�nl' ,rf.'.`'rir
<br />1 1 1
<br />�,.P%f'r'/e'
<br />f f.f
<br />r i'r'fr✓«.n° f fi""
<br />r°
<br />✓
<br />rl P r'TE
<br />fr{{d. fi3 f
<br />.r.-�r �rs.r`xi"�f,.��#'xr.,s"rfvf'■■
<br />.,/!/ 1/ >*`.%'.%`r"Ir
<br />_■
<br />!,fr°'r�.'%f��a'�frdv}.✓''.
<br />ff'..`xr'�.r%�
<br />''' 1�''��:,'�f�sv�.�✓
<br />■
<br />■
<br />_
<br />■
<br />■
<br />■ ■
<br />■
<br />■■
<br />■
<br />■
<br />® CATEGORY
<br />■■■■■-®5`;'fi'F/'s''`fi'.r:"f�`�%!'
<br />r.
<br />.x,. :..
<br />, ,,
<br />.. r o
<br />,l ds"fiB f1"�.^`.r`1
<br />E'`'r'r'if!`f{r'`
<br />:l{.?f
<br />df'/v`ra#`.:+"jlrfs,"
<br />;Y{✓�{{'flife' f r'J6,/,r
<br />> s.,'r
<br />/.#?�J"fir'�`'�f%f..`✓��:}"fi'%`},`�'�,+',�..''.f'.,�r.'f!'of`,:+'!jrf"✓i?'..,."r',�%�ffYl
<br />f}/lfJl
<br />�1r"lrs`t"!✓'
<br />6.r'!'�
<br />1f:+"rlf"
<br />r's';✓f{'✓'fl.:*f%`Pl�sfr.,.l�idt,^rt"ftll
<br />r"lr��r`rv1
<br />.✓Yd.°tf Ya
<br />`.*.Yi.
<br />�
<br />?'' f
<br />v.,`'�
<br />��'>r'�e''
<br />is .{
<br />;'f�%,
<br />„!a` s'✓'.+"v'r
<br />dl/1✓i{i«Jr"
<br />1i#r,.r/r}°f"fr".''"!f%.'�i
<br />>.r/.a'.6.F,*`
<br />'. `�.
<br />1,{°i°{°.
<br />�
<br />1
<br />:- .^ #...
<br />5.�.. -
<br />._ .✓'t°lis ,fi.,°'iir
<br />rrf :.. _"flffr..#
<br />�-�Y�;>�
<br />rr'l. 1. f#`°s',
<br />.e
<br /># -. r.:.
<br />>. /
<br />r P" i^>P� .1.1f'*.i"z
<br />• r
<br />!s l'.s{.. 'r *,lJ.,
<br />- � °�.,
<br />,y .f flr''#i*P
<br />a" f"'. ffi'e'.✓'°s .+".1,. .''a° :
<br />r".x P j`
<br />rr`. ✓Y.a` f�.+'..F
<br />f {'f
<br />�.. r
<br />x''rs/...v. i!/: '.fi„s`3', r° r'J"". T
<br />w � ,' ,
<br />t'lr°frr :",.f"./'s',r'"i if`.
<br />.Y}`'. r`'r'`i" s'1' .? f'ffi.rlll
<br />F.r'r'..
<br />'.�
<br />tr .f z..ra.`..r'r ,.i'e"prd'a
<br />P`i"
<br />�
<br />r'� a°d s':'S` s'e' v",«l"
<br />� ,*�
<br />.PaFY'fi' f�1..
<br />.:'"r^
<br />n^:.
<br />.e"✓'i".#..r
<br />sr:"^{:..f r
<br />1"f.'f`, rfi��i�
<br />11'J"'J'..!>' nf.: ,F„r'�''.
<br />l/ f fi e'�rB>`Ir",l.rs`d
<br />tr. ✓x'�d �9,i°.:dF'. �
<br />i ..F'`� :
<br />i./ i". 1... t`fa`. .✓.;°d
<br />�.+#.�.rl}�' }�.r�r. .£f
<br />lr f}v':f
<br />F'i" .r ir.+:..r
<br />�.
<br />I"A''.'..#✓' f.t✓1
<br />ir�.+ret6l:e..�{s�.rofr.%....�lf..,#n���.�✓ri��4`Fs"ffifr{��..s>�s
<br />t✓`9/ri
<br />x r.?."1`°'lF"{fi:^'{
<br />s .lJ'::.o.,f#'"a''i"
<br />f/ff`I'//df.r`et
<br />/r`
<br />rt".1��''.
<br />r .%rff.{
<br />if l..
<br />s
<br />i'f
<br />ll .P',".fl✓
<br />f raJ r
<br />r"'l:°s'/
<br />."r...
<br />{l'3� t' •;y
<br />.fi�
<br />`.r°f.
<br />.e"..':s°ar
<br />r` l s°�r'd{•'
<br />F. rr"i!"frrF`
<br />r..>"1
<br />'3s
<br />.`x"
<br />f'r^'/
<br />1001
<br />e'r',la aJ /Ffr°fifF`
<br />,fis I.rf ##! .!
<br />1�r!✓{`x.{r.�r�p�%s�'✓!f{'dl.'rB'3'e*f",rr'/✓''tf«P�.l,fif!:'i��
<br />afife{,+v°�}«+".%
<br />.�{',�'`11,fi}r1,��{fdf:+:-r*ilfY�#'.r'"F,+,frr'�',�'•r'��``�'�'�'�,
<br />s ' l,*3�.3-'r'.+"
<br />r� r + J/f✓/.1/s'�^."`#..#`
<br />Fr,✓#6,J':^'x"r r«P r./.�Fr� r'.?,r."'!
<br />MR / 1ar
<br />f r�i`a' .I''f.✓✓I
<br />✓d`v �. r'.:s�C"
<br />} YY��Yi"{.^<'s./{sr
<br />:F�nfi1t E".°.i 3nr:'11����'r��■■
<br />i`fi°ff j'f ✓"'` /�
<br />r
<br />I _■■■■■■■■■
<br />• 1 !'1 •
<br />• . I{1!j! I''!1! '11!!!�t • I
<br />•CATEGORY
<br />IJOB
<br />II„ii„i!,��
<br />SEEM
<br />F
<br />r .. .
<br />fr..
<br />, , ,
<br />HIM®r,Y+rrs/✓#'
<br />- .. ..., ,. r . , ,-
<br />":Y.a s.
<br />�ffi"
<br />+'{"t ..+`
<br />r'!fi'..*'a°
<br />,ll.'".6P."`/r`"/✓..
<br />{{".
<br />,? ,"r'{.r"`
<br />/'v'• / f r
<br />f%. 1's#'d"'✓r
<br />f"f a?'e�..1.*r
<br />�1�
<br />.}r'f s°Yr`.+'.✓.f
<br />s' r#« l✓°s^`,±x'!«r«:^'.l"sl.."x`v
<br />,x'Jfi}iFf�,
<br />eY%.r.` 9r'✓
<br />/ C`..{✓i«i«
<br />d`fir..✓.
<br />s°` P".ff#,
<br />.%!'.s'f.lf'�p�.!`/r}`1f.l.rfd.
<br />,.%.,.i
<br />.r"r°r'l'ff.�x',3,"{}
<br />a°� i`1'.✓.0".l'✓. 9"J"9"v"'
<br />'fd`.r".da''.f1` d'}"e¢`fi
<br />.l.+r -,r .s" t"s"}��F.Ar°l':/'fi
<br />}lr'.'t''r,F1v°<`x°'fi'r�
<br />� 1✓"'.F:.
<br />Y.2''f:+''/l'.r`P.1`i#fi
<br />.€.F. ,"l'rf
<br />tt.l✓g ./` 1'-
<br />5°�"df`.%`
<br />r`. ,d}".,+`
<br />fl'r`f.lf'
<br />.`. !'Af,',rfir'
<br />lrirf+"f``.%£{�i".':rF."''F``l`,
<br />{F f{. try
<br />d". syt' lrPi,!"d"
<br />i' d'�:±'s° ..1.%9'.! #�✓°.+'',s.{^i°".+a
<br />t" 6'F'}"'F"/'fie^"f.
<br />v{t'i"fi`F{l'.✓F`f
<br />���,f`1'"i�fir
<br />f.r'
<br />v"%fP"?'✓e''%r
<br />,dr'.+'f;�sr'fff;,fe'�'
<br />-{,/'/`f,..�.+!
<br />.3ii2rd'f`
<br />s"�/{
<br />:",..
<br />a'':!,ie"`
<br />fn�x'J`%it
<br />rrtf ✓n#.+rF.ff'
<br />r°
<br />Y
<br />,*F
<br />i i
<br />°F" dF..e"' 1"/fl
<br />r'' �
<br />e".:;1°f"�! a°✓
<br />✓� f
<br />C f%x"
<br />r f
<br />d'"r' 9' .f,rre`v
<br />- �' 'r-f
<br />/r , l% .*'s9
<br />r" e'�/
<br />fl'//,%{
<br />/. f e' r. ,.
<br />I`rr.. �a J'rJ/±.d.*%1`i.2r .l�rTi...
<br />,r. f r .. i,. ,^'1.. a ,!
<br />f' rrt �. r .il#>r�J`+`d� rra`�f
<br />.!"s',✓� x'' >
<br />��,
<br />fi�x"'`9��!'t:f`
<br />`Ft. ,I�
<br />f«p}.n*%rra.
<br />rf•�it""
<br />:.�. ff,"e'
<br />.r i�r
<br />,:fe�����.>✓
<br />...�
<br />f"/ sl`
<br />ir'.r".. f f
<br />, f"
<br />.e, f l
<br />:° C�l;✓s'`1
<br />f � r^`��.'r".
<br />�r°��x�
<br />r{ ,^' f. fP.lf�
<br />P�✓`.#>is'%.*ds"J''s",^s
<br />�'.^'v:�r'J
<br />i, #��
<br />,i dPf�<�J�i`F3.i
<br />�!'. �.✓J
<br />s
<br />;.�
<br />dr*'
<br />e', r.f%>`il..:>°r"
<br />✓` .1`frr!
<br />f .O�✓�d_��l�f�#`1�+"�"�al
<br />i/ �.
<br />.s•:{a't"
<br />.✓f' f°✓..±1e"'dxf'f'!�
<br />J. ✓' f p r':
<br />s$� 19
<br />P• Y.e'."ry;f�}
<br />lft:. r",r'.%'✓/1
<br />Pffifll.0
<br />a"
<br />{e f.fi.
<br />.rf✓1/0'��frf.".,'.,.
<br />lvf Pell
<br />....1' I",.f
<br />."%# .e`d
<br />d`
<br />l
<br />�*�.d^'r"
<br />r°+'A
<br />d�r� ,+`8/ t.%S%„"fi
<br />�fa•f�•i,•±^'!".n`rr6ltr
<br />rr."'✓`i6'a"F1'.,e1f"dA�:+'',l�%.r°I:i/lf
<br />r"r`F'l` rxi
<br />vrrl,{ �' r" sxs°r`f'.?.t'.F,,,'rrrlP,+f
<br />9` ."`{`.✓ !e` !� 1" f f.+id'{d` �� lr
<br />'rlr%/ r'*f/!" r`l�r✓ l
<br />ME
<br />HIM
<br />0
<br />MENNEN
<br />/ r""
<br />r'i `f` :'',+"f''{.%l if
<br />r"��`�F`d?";t✓
<br />,,t'..".'" .r /.i.✓�`l
<br />ly ✓"�,n" ✓.✓ P1'�"v'Fj l x- llr"xr{
<br />1°+.PI.Ftffi r'✓ ,"J of J+'`ja
<br />�izf'r.,f%.*Y'!,^�`� f,%"-�sti
<br />■■
<br />_■■■■■■■■■
<br />}�✓ s` BOl.
<br />� .:1�f
<br />i'frf;'����s�
<br />,". i .+'"..edrf�dl � .✓„'..I.fn''}■■
<br />ar` s•�i'�
<br />_■
<br />Totals 10 10 10 10 1 0 1 0 10.00 M 0 MENSMINJIMEM 0 1 0 ffffm 0 10 10 10
<br />Certification: I certify the information provided on this form is complete and correct to the best of my knowledge.
<br />Authorized Signature
<br />Title
<br />Date
<br />
|