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Floor Coverer Work Card - KAUKAUNA
Name:
Phone:
Address:
City, State, Zip:
Email:
Current Wage:
Work Month/Year
Day
Sheet Goods
Poly Vinyl
Carpet
Tile/Asphalt/Wood
Rubber
Metals
Misc
Total Hours
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total
List of Employers for this Month
Present Employer:
Date Employment Started:
Construction Project:
List ALL Hours to Date:
Courses You Are Currently Enrolled In:
Previous Employer:
Start Date:
End Date:
Previous Employer:
Start Date:
End Date:
Previous Employer:
Start Date:
End Date:
Previous Employer:
Start Date:
End Date:
Previous Employer:
Start Date:
End Date:
Previous Employer:
Start Date:
End Date:
Presently Laid Off:
Yes
No
Date of Layoff:
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