census 2

Confidential Employee Census
#	EMPLOYEE NAME	SEX	AGE	STATUS	SALARY	TITLE
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55

Please complete and fax this form to Medical Solutions  at: (212) 302-0222 or

E-Mail [email protected]
For Questions, please call us at (914) 207-6161 or toll-free at (855) 677-4621