Fillable Tribal Employee Other Employee Unemployed (Sisseton Wahpeton Oyate)

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Tribal Employee Other Employee Unemployed (Sisseton Wahpeton Oyate)

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August 2017/cf
Date:
First Name: Last Name:
Volunteer Category:
Tribal Employee
□
Other Employee
□
Unemployed
□
List Equipment Utilized: Start Time End Time
1)
2)
3)
4)
5)
Assistance Category (check all that apply):
Emergency Shelter
□
District/Locations:
Debris Removal
□ District/Locations:
Roads Assistance
□ District/Locations:
Other:
□ Describe:
Volunteer Signature: Date:
Supervisor Signature: Date:
Rate of Pay: Mileage Rate: EMS Initials:
Description of Duties
Authorization
For Office Use Only
Equipment Utilized
Total Time
SWO EMS Equipment Use Form
Volunteer Information
Department Employed:
Place of Employment:
Address:
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Tribal Employee Other Employee Unemployed (Sisseton Wahpeton Oyate)

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Completed 20 July 2020

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