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11
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Applicant Employment Information
Income Interval*
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Bi-Weekly
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Employment Status*
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Employment Type*
Auto Worker
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AR
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CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
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NS
NV
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OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years*
0
1
2
3
4
5
6
7
8
9
10+
Months*
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Previous Employment Information
Employment Status*
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type*
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years*
0
1
2
3
4
5
6
7
8
9
10+
Months*
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Additional Income Information
Applicant Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence*
Years*
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months*
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type*
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Marital Status
Married
Unmarried
Separated
Applicant Employment Information
Income Interval*
Weekly
Bi-Weekly
Monthly
Employment Status*
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type*
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years*
0
1
2
3
4
5
6
7
8
9
10+
Months*
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Previous Employment Information
Employment Status*
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type*
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years*
0
1
2
3
4
5
6
7
8
9
10+
Months*
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Additional Income Information