Wp.sbcounty.gov
Customer Name:SSN: XXX-XX-Category: FORMCHECKBOX Adult FORMCHECKBOX DW FORMCHECKBOX Other:Enrolled in Training? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, date training credential awarded:Exit Date:Exit Reason(s):1ST QUARTER – POST EXIT: (dates)Earnings? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, rate of pay:$If Yes, earnings are: FORMCHECKBOX Wage DB File and/or FORMCHECKBOX Supplemental DataEDD reported wages for the Quarter = $2ND QUARTER – POST EXIT: (dates)Earnings? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, rate of pay:$If Yes, earnings are: FORMCHECKBOX Wage DB File and/or FORMCHECKBOX Supplemental DataEDD reported wages for the Quarter = $3RD QUARTER – POST EXIT: (dates)Earnings? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, rate of pay:$If Yes, earnings are: FORMCHECKBOX Wage DB File and/or FORMCHECKBOX Supplemental DataIf training provided, obtained training credential? FORMCHECKBOX Yes FORMCHECKBOX NoEDD reported wages for the Quarter = $ ................
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