Who was your principal employer during the week of February 1, 2013?
If you had more than one job, report the one for which you worked the most hours that week.
If your employer had more than one location, report the location that employed you.
If you worked for a contracting or consulting company, report the name of that company, not the client organization.

Employer Name: ________________________________
Department/Division: ____________________________
City/Town: _____________________________________
State: _________________________________________
ZIP code: ______________________________________

Who was your principal employer during the week of February 1, 2013?
If you had more than one job, report the one for which you worked the most hours that week.
If your employer had more than one location, report the location that employed you.
If you worked for a contracting or consulting company, report the name of that company, not the client organization.

Employer Name: ________________________________
Department/Division: ____________________________
City/Town: _____________________________________
State: _________________________________________
ZIP code: ______________________________________

Who was your principal employer during the week of April 15, 1999?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked

Employer Name: _________________________________________
City/Town: ______________________________________________
State/Foreign Country: ____________________________________
ZIP Code: ________________________________________________

Who was your principal employer during the week of April 15, 1999?
If more than one job: Record employer for whom you worked the most hours that week
If employer had more than one location: Record location where you usually worked

Employer Name _______________________________________________
City/Town ____________________________________________
State/Foreign Country ____________________________________________
ZIP Code ______________________________________________

Who was your principal employer during the week of April 15, 1999?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week.
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked.

Employer Name: ______________________________
City or Town: _________________________________
State/Foreign Country: __________________________
ZIP Code: ____________________________________

Who was your principal employer during the week of April 15, 1997?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked

Employer: _____________________________
Name: ________________________________
City/Town: _____________________________
State/Foreign Country: ____________________
ZIP Code: ______________________________

Who was your principal employer during the week of April 15, 1997?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked

Employer Name: ______________________________________
City/Town: __________________________________________
State/Foreign Country: _________________________________
ZIP Code: ___________________________________________

Who was your principal employer during the week of April 15, 1997?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week.
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked.

Employer Name: _____________________________
City or Town: ________________________________
State/Foreign Country: _________________________
ZIP Code: ___________________________________

Who was your principal employer during the week of April 15, 1995?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked

Employer Name: ______________________________________
City/Town: ___________________________________________
State/Foreign Country: __________________________________
ZIP Code: ____________________________________________

Who was your principal employer during the week of April 15, 1995?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked

Employer Name: ______________________________________
City/Town: __________________________________________
State/Foreign Country: _________________________________
ZIP Code: ___________________________________________

Who was your principal employer during the week of April 15, 1995?
IF MORE THAN ONE JOB: Record employer for whom you worked the most hours that week
IF EMPLOYER HAD MORE THAN ONE LOCATION: Record location where you usually worked

Employer Name: ____________________________________
City/Town: _________________________________________
State/Foreign Country: ________________________________
ZIP Code: __________________________________________

Employer Name: ________________________
City/Town: _____________________________
State/Foreign Country: ___________________

Who was your principal employer during the week of April 15?

Employer: _________________________________
Name: ____________________________________
City/Town: ________________________________
State/Foreign Country: _______________________
ZIP Code: _________________________________