acement 3,4,6 II Discharged 1,6 ll Title or Position 1.2.3.8 • Repayment Schedule II Per Pay Day With 0 II Rehire 2,3.6 I) Released I,6 ti Department or Branch 1,2,3,6 (I Reinstate ve " F ea 2,3,6 )1 Laid Off 1,6 Shift (Day/Night) 1,2,36 Balance From Any Bonus ' K Total Repayment From B