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- Select type of submission
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- Birth_Date*
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- Hire_Date*
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Format: 0000000000.
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Format: 0000000000.
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Format: 0000000000.
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- Termination_Date
- ReHire_Date
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- ER_Eligibility_Date
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- Compensation Effective Date
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- If you answered Yes, what date were any final contributions remitted?
- If you answered No, what date will any final contributions be remitted?
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- Would you like to submit information for another employee?
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- Should be Empty: