upr000112 15

(1) NAME OF EMPLOYEE (8) SEX (3) AGE (4) NATIONALITY OR COLOR (5) ADDRESS (6) OCCUPATION (7) WAGES PER DAY (8) HOURS PER DAY (9) AMOUNT OF PAY-CHECK, NOV., 1917 (10) DAYS WORKED PER ANNUM Name in full must be written, placing the family or surname last. If employee is a woman the pre­fix 1 Miss” or |Mrs.” must be added Write the word $ male” or " female” as the case may be years only are required Use only four color designations. Write the words | White,” " Negro,” " Japanese,” or | Chinese” Give name of place of usual employment. In transportation industries give the name of the " home terminal” State clearly the trade name most commonly used to describe the occupation If no fixed daily wage is paid a fair average must be stated [f no fixed lours show fair average The exact amount of pay-check issued or money actually paid must be shown. If absent give reason Do not include days 1 such as Sundays, lolidays, or periods 1 of lay-off or vaca­tion, unless such lays were paid for 1 f it / , - ^ $ 3 / o i f if y iC iw t s ? 1 | ft - n p h 1 / f /CC*y „ 1 i 3 4 o . ~ T ~ ? / ...... 1 ________™ ____ :-------------- i — i | {--------------- :— :---------------------------