| A. Employer / Company | B. Employee First Name | Last Name | Employee No: | Employee Job Title / Description |
|---|---|---|---|---|
| Comstock Gold Mine | Glenn | Hale | 123 | Miner |
| Comstock Gold Mine | Diane | Krause-Hale | 123 | Miner |
| A. Employer / Company | B. Employee First Name | Last Name | Employee No: | Employee Job Title / Description |
