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Department of Labour Salary Schedule Form

|ID NUMBER OF EMPLOYEE | |

|SURNAME & INITIALS OF EMPLOYEE | |

|EMPLOYER REFERENCE NUMBER | |

|EMPLOYER NAME | |

|PERIOD OF SERVICE | |

| |From: Month & Year |To: Month & Year |Remuneration |Hours worked |Contributor Y/N | |

|  | | |per month |per month | | |

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❖ PLEASE INDICATE FULL DATE FOR EACH SALARY ADJUSTMENT

Name & Surname: _________________________________________________

Signature: ________________ Date: ________________

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