8850_Reference|8850_FEIN|8850_Employer|8850_First_Name|8850_Last_Name|8850_SSN|8850_Address_1|8850_Address_2|8850_City|8850_State|8850_Zip|8850_ZipExtn|8850_County|8850_Telephone|8850_DOB|8850_Conditional|8850_Conditional_Next|8850_Unemployed_Vet_6|8850_Service_Connected_Vet|8850_Service_Connected_Vet_6|8850_TANF|8850_Unemployed_27|8850_Signature_Date|8850_TargetGroup_4_or_6|8850_Applicant_Gave|8850_Applicant_Offered|8850_Applicant_Hired|8850_Start_Date|8850_Employer_Sign_Date|9061_Previously_Employed|9061_Last_Employ_Date|9061_Starting_Wage|9061_Position|9061_TANF_9|9061_TANF_Recipient|9061_TANF_City|9061_TANF_State|9061_Veteran|9061_SNAP_3_Recipient|9061_SNAP_3_City|9061_SNAP_3_State|9061_Felon|9061_Work_Release|9061_Conviction_Date|9061_Release_Date|9061_Federal_Conviction|9061_State_Conviction|9061_Conviction_State_Code|9061_RRC|9061_Empowerment_Zone|9061_DRC_Birth_Date|9061_VR_Referral|9061_Summer_Youth|9061_Summer_Youth_Birth_Date|9061_SNAP|9061_SNAP_Birth_Date|9061_SNAP_NLR_Recipient|9061_SNAP_NLR_City|9061_SNAP_NLR_State|9061_SSI_Within_60_days|9061_TANF_Max|9061_LongTermTANF_Recipient_Name|9061_LongTermTANF_Recipient_City_Name|9061_LongTermTANF_Recipient_State_Code|9061_Unemployed_27_weeks|9061_Unemployment_Benefits_City_Name|9061_Unemployment_Benefits_UI_State|9061_Sources_of_Eligibility_Text|9061_Signed_this_Form|9061_Signature_Date
0001|123456789|Pete's Crash and Burn Inc|Ken|L|123551211|Address 1||City Name|WI|12345|5656|County|1231231234|12/21/1900|N|N|N|N|N|N|N|09/01/2016|4|09/01/2016|08/01/2016|08/31/2016|09/30/2016|09/01/2016|N||40.22|17|Y|||WI|N|N|||N|N|||N|N||N|N||N|N||N|||||N|N||||N|||Source Docs||09/01/2016
0002|123456789|Pete's Crash and Burn Inc|Niva|K|223451212|Address 1|Address 2|City Name|WI|12345|5656|Dane|1231231234|12/21/1900|N|N|N|N|N|N|N|09/01/2016|4|09/01/2016|08/01/2016|08/31/2016|09/30/2016|09/01/2016|N||30.00|17|Y|||WI|Y||||Y|N|||Y|N||Y|N||Y|Y||Y|||||Y|Y||||Y|||Source Docs||09/01/2016
0003|123456789|Pete's Crash and Burn Inc|Amy|H|323451213|Address 1|Address 2|City Name|WI|12345|5656|County|1231231234|12/21/1900|N|N|N|N|N|N|N|09/01/2016|4|09/01/2016|08/01/2016|08/31/2016|09/30/2016|09/01/2016|N||25.50|17|N||||N|N|||N|N|||N|N||N|N||N|N||N|||||N|N||||N|||Source Docs||09/01/2016
0004|123456789|Pete's Crash and Burn Inc|Amy|H|323451217|Address 1|Address 2|City Name|WI|12345|5656|County|1231231234|12/21/1900|N|N|N|N|N|N|N|09/01/2017|4|09/01/2017|08/01/2017|08/31/2017|09/30/2017|09/01/2017|N||25.50|35|N||||Y|N||TX|N|N|||N|N||N|N||N|N||N|||||N|N||||N|||Source Docs||09/01/2017