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ector of Personnel" J.' .../ , / 12- :;-. . .....Y 7 / ADP CODES CATEGORY 0 1 2 3 4 5 6 7 8 9 Effective Date 401 Major Medical 402 Blue Cross 403 Type Employee 404 Birth Date 392 i fi LW% Annual Salary 762 Clock Number 330 i 40 7 / 1/4 ' a. 1 354 Rev. 10/75 (8/76) PERSONNEL
and that each of my responses thereto is true and complete. I authorize my prior employers to make available to any prospective employer, or to any Federal, State or Municipal agency, any information it may have concerning me, and I hereby release my employers frHn any and all liability of whatsoever nature by reason of f
Department Had or 8finth.Monager Director of Perscel ADP CODES CATEGORY 0 1 2 3 4 5 6 7 8 9 Effective Date 401 Meier Medical 402 Blue Cross 403 type Employee 404 31 Date 392 OW ./ 4 Vernal Slant 762 lock Number 330 W 74 1/7/ i 354 Rev. 10/75 (8/76) PERSONNEL COPY SDNY_GM_0
and that each of my responses thereto is true and complete. I authorize my prior employers to make available to any prospective employer, or to any Federal, State or Municipal agency, any information it may have concerning me, and I hereby release my employers f any and all liability of whatsoever nature by reason of f r
anch Manager Administrative Partner Director of Per ADP CODES CATEGORY 0 1 2 3 4 5 6 7 8 9 Effective Date 401 t Major Medical 402 Blue Cross 403 Type Employee 404 Birth Date 392 V ;Oi l / Annual Salary 762 Clock Number . 330 '',7 /Y/ 7/ 354 Rev. 1O/75 (8/7O PERSONNEL COPY
and that each of my responses thereto is true and complete. I authorize my prior employers to make available to any prospective employer, or to any Federal, State or Municipal agency, any information it may have concerning me, and I hereby release my employers fr n any and all liability of whatsoever nature by reason of f
Entities connected to both Blue Cross and Federal, State or Municipal

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