fees refund Log Date weekly week employer name, Applicant Name, day Hired pay Date Fee Paid by: address and Address and notes available Or request of per per of (E)-employer Reason for Of for phone number Phone number of paid (Y/N) PAID OR Applicant Fee Start refund rate (A)-Applicant date date Demand refund refund HOurs Applicant Provided Date Application amount FEE reason Positions date HOURly ABC Employer 1/1/14 nanny 9 hrs/ 40 hrs/ $17/hr Susie Jones 1/2/14 N n/a A $120 1/2/14 Deposit for Job 1/8/14 1/8/14 $120 Not Placed N/A 123 Job Street day week 123 Home Street Placement Queens, NY Queens, NY Assistance (718) 555-5555 (718) 111-1111
employer name, address and phone number date of request Positions available per day HOurs per week HOURly Or weekly rate of pay Applicant Name, Address and Phone number Application Date Applicant Hired (Y/N) Start Date fees refund Log notes Fee Paid by: (E)-employer OR (A)-Applicant FEE PAID Date paid Reason for Applicant Fee date Of Demand date refund Provided amount of refund reason for refund ABC Employer 1/1/14 nanny 9 hrs/ day 40 hrs/ week $17/hr Susie Jones 1/2/14 N n/a A $120 1/2/14 Deposit for Job Placement Assistance 1/8/14 1/8/14 $120 Not Placed N/A 123 Job Street Queens, NY 123 Home Street Queens, NY (718) 555-5555 (718) 111-1111
EmploymentAgency_RegisterandRefundLog.docx