ࡱ> $&!"#@ bjbj (uue"666878"H: dE(EEEIIK|OMsuuuuuu$0RriTHIITTEE#&r&r&rT`EEs&rTs&r&r6w6yE: 6v[fx{0Hx@b8y4"ylNO0&rPQ9NNN""d+1Drj""1 STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS PROFESSIONAL EMPLOYER ORGANIZATIONS S.C. Code Ann. 40-68-10 et seq.  HYPERLINK "http://www.state.sc.us/consumer" www.scconsumer.gov (803) 734-4200 Restricted License List of Leased Employees (Please type or print in black ink) Please provide the information requested below for ALL leased employees working for the Applicant in the State of South Carolina. The South Carolina Freedom of Information Act may require the Department of Consumer Affairs to release this form as a public record; however personal identifying information will be released only if required by law. #Employee NameSocial Security No. Client Company1 FORMTEXT       FORMTEXT       FORMTEXT      2 FORMTEXT       FORMTEXT       FORMTEXT      3 FORMTEXT       FORMTEXT       FORMTEXT      4 FORMTEXT       FORMTEXT       FORMTEXT      5 FORMTEXT       FORMTEXT       FORMTEXT      6 FORMTEXT       FORMTEXT       FORMTEXT      7 FORMTEXT       FORMTEXT       FORMTEXT      8 FORMTEXT       FORMTEXT       FORMTEXT      9 FORMTEXT       FORMTEXT       FORMTEXT      10 FORMTEXT       FORMTEXT       FORMTEXT      11 FORMTEXT       FORMTEXT       FORMTEXT      12 FORMTEXT       FORMTEXT       FORMTEXT      13 FORMTEXT       FORMTEXT       FORMTEXT      14 FORMTEXT       FORMTEXT       FORMTEXT      15 FORMTEXT       FORMTEXT       FORMTEXT      16 FORMTEXT       FORMTEXT       FORMTEXT      17 FORMTEXT       FORMTEXT       FORMTEXT      18 FORMTEXT       FORMTEXT       FORMTEXT      19 FORMTEXT       FORMTEXT       FORMTEXT      20 FORMTEXT       FORMTEXT       FORMTEXT       #Employee NameSocial Security No. Client Company21 FORMTEXT       FORMTEXT       FORMTEXT      22 FORMTEXT       FORMTEXT       FORMTEXT      23 FORMTEXT       FORMTEXT       FORMTEXT      24 FORMTEXT       FORMTEXT       FORMTEXT      25 FORMTEXT       FORMTEXT       FORMTEXT      26 FORMTEXT       FORMTEXT       FORMTEXT      27 FORMTEXT       FORMTEXT       FORMTEXT      28 FORMTEXT       FORMTEXT       FORMTEXT      29 FORMTEXT       FORMTEXT       FORMTEXT      30 FORMTEXT       FORMTEXT       FORMTEXT      31 FORMTEXT       FORMTEXT       FORMTEXT      32 FORMTEXT       FORMTEXT       FORMTEXT      33 FORMTEXT       FORMTEXT       FORMTEXT      34 FORMTEXT       FORMTEXT       FORMTEXT      35 FORMTEXT       FORMTEXT       FORMTEXT      36 FORMTEXT       FORMTEXT       FORMTEXT      37 FORMTEXT   9:;<=_`an̲n^N>+%hH^:hh5>*CJOJQJ\aJhhB*CJOJQJaJphh~tB*CJOJQJaJphhnB*CJOJQJaJph(jhH^:hnCJUaJmHnHu3jhn5>*CJOJQJU\aJmHnHu(jhH^:hhCJUaJmHnHu3jhh5>*CJOJQJU\aJmHnHuhhhCJOJQJaJhhCJOJQJaJ0jhhhCJOJQJUaJmHnHu 9a  + ,    `'L`'L`'V`'V`'V`'V`'0`'V`'V`'`'`'`'`'`'`'`'$a$gdjHQ$a$gdk$a$gd@I$a$gd$$a$gd*$a$gdJ[M$a$gd~t$a$gd %d O gdh$%d O a$gdC Mb,nprw{}~;|gO|A|g,)hnB0J56:;CJOJQJ\aJhw0JCJOJQJaJ.jh`Z"hhCJOJQJU]aJ)h`Z"hh0J56CJOJQJ\aJ2jh`Z"hh0J56CJOJQJU\aJ)hh0J56:;CJOJQJ\aJ%hhhh5>*CJOJQJ]aJhh5CJOJQJ]aJhJ[M5CJOJQJ]aJ"hH^:hh5CJOJQJ]aJ"hH^:hh5CJOJQJ\aJ    * + ,  Ÿ{ocWK3/h2hr=5>*B*CJOJQJ^JaJphhr=CJOJQJaJhkCJOJQJaJh$CJOJQJaJhbCJOJQJaJh$hJ[MCJOJQJaJh~tCJOJQJaJh$hJ[M5>*OJQJh=5>*OJQJh0W5OJQJh~t5CJOJQJaJh 5CJOJQJaJ/hH^:hh0J56:;CJOJQJ\aJ)hh0J56:;CJOJQJ\aJ      2 4 X Z \ ^ z | ~ óym^NChjHQ5OJQJ^JjhjHQ5OJQJU^Jh0Wh0WCJOJQJaJh0WCJOJQJaJhW5CJOJQJaJhjHQhjHQ5CJOJQJaJhhhjHQ5CJOJQJaJhh5CJOJQJaJh$hjHQ5CJOJQJaJh$h$5CJOJQJaJhjHQCJOJQJaJhkCJOJQJaJ(hr=h@I>*B*CJOJQJaJph  4 ^ | Z* Z ZZ $$Ifa$gdjHQ| ~ ,/#Z $Ifgd0Wkd$$Ifl\)   t(00*644 lap(     $ & ( ڷڬڷڬڷ|paڬKڷ*jhjHQh:5OJQJU^Jh0Wh0WCJOJQJaJh0WCJOJQJaJh0W*jhjHQh:5OJQJU^J*jQhjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHujhjHQ5OJQJU^J*jhjHQh:5OJQJU^J ( P x  aPGZ* a aa $Ifgd0Wkd9$$Ifl\)  t00*644 la $$Ifa$gdjHQ( * > @ B L N P R f h j t v x z | ~ 𬒆waK*j3hjHQh:5OJQJU^J*jhjHQh:5OJQJU^Jh0Wh0WCJOJQJaJhjHQCJOJQJaJh0W*jhjHQh:5OJQJU^JhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHu*jBhjHQh:5OJQJU^JhjHQ5OJQJ^JjhjHQ5OJQJU^Jx z ~ \/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd*$$Ifl\)  t00*644 la    " $ & : < > H J L N b ⨙t^*j&hjHQh:5OJQJU^J*jhjHQh:5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0W)jhb!5OJQJU^JmHnHu*jhjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0W5OJQJ^JjhjHQ5OJQJU^J $ L t \/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 lab d f p r t v x z | ڷڊtڷڊ^ڷڊH*j hjHQh:5OJQJU^J*j hjHQh:5OJQJU^J*j hjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0WhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHujhjHQ5OJQJU^J*jhjHQh:5OJQJU^Jt v z \/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd $$Ifl\)  t00*644 la  "68:DFHJ^`blnprtvxϿs]Ͽ*j hjHQh:5OJQJU^J*j hjHQh:5OJQJU^J)jhb!5OJQJU^JmHnHu*j hjHQh:5OJQJU^JhjHQ5OJQJ^JjhjHQ5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0WhjHQh0W5OJQJ^J Hp\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd $$Ifl\)  t00*644 laprv\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd $$Ifl\)  t00*644 la  ڷڬڷڬڷ|m^ڬH*jhjHQh:5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0W*jhjHQh:5OJQJU^J*j hjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHujhjHQ5OJQJU^J*j hjHQh:5OJQJU^JDl\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 la246@BDFZ\^hjlnprt֕s]*jhjHQh:5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0W*jxhjHQh:5OJQJU^J)jhb!5OJQJU^JmHnHu*jhjHQh:5OJQJU^JhjHQ5OJQJ^JjhjHQ5OJQJU^JhjHQh0W5OJQJ^Jlnr\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 la  024>@ڷڬڷtڬ^ڷڬH*jhjHQh:5OJQJU^J*jzhjHQh:5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0W*johjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHujhjHQ5OJQJU^J*jhjHQh:5OJQJU^JBj\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 la@BDXZ\fhjlprt񧘉s]*jhjHQh:5OJQJU^J*jqhjHQh:5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0W)jhb!5OJQJU^JmHnHu*jfhjHQh:5OJQJU^JhjHQ5OJQJ^JjhjHQ5OJQJU^JhjHQh0W5OJQJ^Jjlr\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 la  024>@BDXZ\fhڷڊtڷڊ^ڷڊH*jThjHQh:5OJQJU^J*jhjHQh:5OJQJU^J*jhhjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0WhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHujhjHQ5OJQJU^J*j]hjHQh:5OJQJU^JBj\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 lahjlprtϿs]Ͽ*jKhjHQh:5OJQJU^J*jhjHQh:5OJQJU^J)jhb!5OJQJU^JmHnHu*j_hjHQh:5OJQJU^JhjHQ5OJQJ^JjhjHQ5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0WhjHQh0W5OJQJ^Jjlr\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 laBj\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 la  024>@BDXZ\fhjlprtڷڬڷڬڷ|m^ڬH*jMhjHQh:5OJQJU^JhjHQh0WCJOJQJaJhjHQhjHQCJOJQJaJh0W*jBhjHQh:5OJQJU^J*jhjHQh:5OJQJU^JhjHQ5OJQJ^JhjHQh0W5OJQJ^J)jhb!5OJQJU^JmHnHujhjHQ5OJQJU^J*jVhjHQh:5OJQJU^Jjlr\/SZG* aG aGa $$Ifa$gdjHQ $Ifgd0Wkd$$Ifl\)  t00*644 la  ֕vf[Eff*jDhjHQh$5OJQJU^Jh$5OJQJ^Jjh$5OJQJU^Jh0Wh$CJOJQJaJh$CJOJQJaJh0W*j9hjHQh:5OJQJU^J)jhb!5OJQJU^JmHnHu*jhjHQh:5OJQJU^JhjHQ5OJQJ^JjhjHQ5OJQJU^JhjHQh0W5OJQJ^JBj\/PZP* aP aPa $$Ifa$gd$kd$$Ifl\)  t00*644 la024>@BDXZ\fhjlprt֕v`J*j!hjHQh$5OJQJU^J*j5!hjHQh$5OJQJU^Jh0Wh$CJOJQJaJh$CJOJQJaJh:*j, hjHQh$5OJQJU^J)jhb!5OJQJU^JmHnHu*jhjHQh$5OJQJU^Jh$5OJQJ^Jjh$5OJQJU^JhjHQh$5OJQJ^Jjlr\/PZP* aP aPa $$Ifa$gd$kd $$Ifl\)  t00*644 la  024>@BDX¬ͨwa*j#hjHQh$5OJQJU^J*j&#hjHQh$5OJQJU^Jh0Wh$CJOJQJaJh$CJOJQJaJh:*j"hjHQh$5OJQJU^Jh$5OJQJ^JhjHQh$5OJQJ^J)jhb!5OJQJU^JmHnHujh$5OJQJU^JBj\/PZP* aP aPa $$Ifa$gd$kd"$$Ifl\)  t00*644 laXZ\fhjlprtڷڍwڷڍaڷڍKڷ*j&hjHQh$5OJQJU^J*j%hjHQh$5OJQJU^J*j%hjHQh$5OJQJU^Jh$5OJQJ^JhjHQh$CJOJQJaJh$CJOJQJaJh:hjHQh$5OJQJ^J)jhb!5OJQJU^JmHnHujh$5OJQJU^J*j$hjHQh$5OJQJU^Jjlr\/PZP* aP aPa $$Ifa$gd$kd$$$Ifl\)  t00*644 laBj\/PZP* aP aPa $$Ifa$gd$kdy&$$Ifl\)  t00*644 la  024>@BDXZ\fhjlrvưћэwћэaћэ]Mh$h@I5CJOJQJaJh@I*j'hjHQh$5OJQJU^J*j'hjHQh$5OJQJU^JhjHQh$5OJQJ^J)jhb!5OJQJU^JmHnHu*j'hjHQh$5OJQJU^Jh$5OJQJ^Jjh$5OJQJU^JhjHQh$CJOJQJaJh$CJOJQJaJh:jlprv\/TT`'HZH* ZH ZHZ $$Ifa$gdjl$a$gd+kdp($$Ifl\)  t00*644 lav   "$.024ɽ}hZDhZ*jo*hjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*j)hjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@ICJOJQJaJh@I5CJOJQJaJhjHQh@I5CJOJQJaJhh5CJOJQJaJ,/#Z $Ifgdjlkd)$$Ifl\)   t(00*644 lap( 2Z\b* a aaP/GZ* a aa $IfgdjlkdW+$$Ifl\)  t00*644 la $$Ifa$gdjl4HJLVXZ\`bdxz|ιΫvιΫ`ιΫJι*j,hjHQh@I5OJQJU^J*j`,hjHQh@I5OJQJU^J*j+hjHQh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*j*hjHQh@I5OJQJU^Jh@I5OJQJ^J   "$.024HJLVXZ\^bdxwaRhjHQh@ICJOJQJaJ*j.hjHQh@I5OJQJU^J*jQ.hjHQh@I5OJQJU^J)jhb!5OJQJU^JmHnHu*j-hjHQh@I5OJQJU^Jh@I5OJQJ^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^Jjh@I5OJQJU^J 2Z\/SZG* aG aGa $$Ifa$gdjl $IfgdjlkdH-$$Ifl\)  t00*644 laZ\b\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd9/$$Ifl\)  t00*644 laxz| ڷڬڷڬڷ|paڬKڷ*j1hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*j0hjHQh@I5OJQJU^J*jD0hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*j/hjHQh@I5OJQJU^J 2Z\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd01$$Ifl\)  t00*644 la   "$.024HJLVXZ\^bdxz|𬒆waK*j24hjHQh@I5OJQJU^J*j3hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*j2hjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*j;2hjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^JZ\b\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd'3$$Ifl\)  t00*644 la   "$.024HJ⨜waK*j6hjHQh@I5OJQJU^J*j)6hjHQh@I5OJQJU^J*j5hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I)jhb!5OJQJU^JmHnHu*j4hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^Jjh@I5OJQJU^J 2Z\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd5$$Ifl\)  t00*644 laJLVXZ\^bdxz|ɽwaɽ*j8hjHQh@I5OJQJU^J*j 8hjHQh@I5OJQJU^J*j7hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J!Z\b\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd7$$Ifl\)  t00*644 la 2Z\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd 9$$Ifl\)  t00*644 la   "$.024HJLVXZ\^bdxz|ڷڬڷڬڷ|paڬKڷ*j;hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*j:hjHQh@I5OJQJU^J*j:hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*j9hjHQh@I5OJQJU^JZ\b\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd;$$Ifl\)  t00*644 la   "$.𬒆waK*j>hjHQh@I5OJQJU^J*j=hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*j<hjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*j<hjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^J 2Z\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd<$$Ifl\)  t00*644 la.024HJLVXZ\^bdxz|⨜waK*jr@hjHQh@I5OJQJU^J*j?hjHQh@I5OJQJU^J*j?hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I)jhb!5OJQJU^JmHnHu*j{>hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^Jjh@I5OJQJU^JZ\b\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd>$$Ifl\)  t00*644 la   "$.024HJLVXZ\^bdxɽwaɽ*jiBhjHQh@I5OJQJU^J*jAhjHQh@I5OJQJU^J*j}AhjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J! 2Z\/SZG* aG aGa $$Ifa$gdjl $Ifgdjlkd@$$Ifl\)  t00*644 laZ\b\/SZG* aG aGa $$Ifa$gdjl $IfgdjlkdB$$Ifl\)  t00*644 laxz| ڷڬڷڬڷ|paڬKڷ*jkEhjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*j`DhjHQh@I5OJQJU^J*jChjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*jtChjHQh@I5OJQJU^J 2Z\/SZG* aG aGa $$Ifa$gdjl $IfgdjlkdD$$Ifl\)  t00*644 la   "$.024HJLVXZ\`bdxz|𬒆waK*jGhjHQh@I5OJQJU^J*jbGhjHQh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@I*jWFhjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*jEhjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^JZ\b\/PZP* aP aPa $$Ifa$gdjlkdF$$Ifl\)  t00*644 la "$.024H⨜wu_*jIhjHQh@I5OJQJU^JU*jSIhjHQh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@I)jhb!5OJQJU^JmHnHu*jJHhjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^Jjh@I5OJQJU^J 2Z\/PZP* aP aPa $$Ifa$gdjlkdH$$Ifl\)  t00*644 la    FORMTEXT       FORMTEXT      38 FORMTEXT       FORMTEXT       FORMTEXT      39 FORMTEXT       FORMTEXT       FORMTEXT      40 FORMTEXT       FORMTEXT       FORMTEXT      41 FORMTEXT       FORMTEXT       FORMTEXT      42 FORMTEXT       FORMTEXT       FORMTEXT      43 FORMTEXT       FORMTEXT       FORMTEXT      44 FORMTEXT       FORMTEXT       FORMTEXT      45 FORMTEXT       FORMTEXT       FORMTEXT      46 FORMTEXT       FORMTEXT       FORMTEXT      47 FORMTEXT       FORMTEXT       FORMTEXT      48 FORMTEXT       FORMTEXT       FORMTEXT      49 FORMTEXT       FORMTEXT       FORMTEXT      50 FORMTEXT       FORMTEXT       FORMTEXT       Affidavit of Applicant I swear or affirm and certify that I have completed and/or reviewed all information on this form, and to the best of my knowledge and belief, all information contained herein is true, correct and complete; and that there are no material omissions of fact which would have a bearing upon the South Carolina Department of Consumer Affairs decision to grant the requested license. I further certify that I understand that giving false information constitutes cause for denial or revocation of the application and subjects me to criminal prosecution for perjury. I acknowledge that I have a duty and agree to update and correct this information as it changes.  Signature FORMTEXT      Date FORMTEXT      Type or Print your name and Title  SWORN TO AND SUBSCRIBED before me this ________ day of _____________________, 20______ ________________________________________________ (SEAL) Notary Public For __________________________________ My Commission Expires: _____________________________ Restricted License Employee List SCDCA Form PEO-16 Revised 10/05 Page  PAGE 1 of  NUMPAGES 3 Street Address 3600 Forest Drive Columbia, SC 29204-4006 Mailing Address P.O. Box 5757 Columbia, SC 29250-5246 Street Address 3600 Forest Drive Columbia, SC 29204-4006 Mailing Address P.O. Box 5757 Columbia, SC 29250-5246 HJLVXZ\`bdxz|ȶʶ̶ֶضڶڷڍwڷڍaڷڍKڷ*j,LhjHQh@I5OJQJU^J*jKhjHQh@I5OJQJU^J*jDKhjHQh@I5OJQJU^Jh@I5OJQJ^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*j;JhjHQh@I5OJQJU^JZ\bڶ\/PZP* aP aPa $$Ifa$gdjlkdJ$$Ifl\)  t00*644 laڶܶ 2Z\/PZP* aP aPa $$Ifa$gdjlkdL$$Ifl\)  t00*644 laڶܶ "$.024HJLVXZ\`bdxưћэwћэaћэ*j!NhjHQh@I5OJQJU^J*jMhjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*j5MhjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@IZ\bڷ\/PZP* aP aPa $$Ifa$gdjlkdN$$Ifl\)  t00*644 laxz|ȷʷ̷ַطڷܷ ڷڬڷڬڷ|paڬKڷ*j#QhjHQh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@I*jPhjHQh@I5OJQJU^J*jOhjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*j,OhjHQh@I5OJQJU^Jڷܷ 2Z\/PZP* aP aPa $$Ifa$gd@IkdP$$Ifl\)  t00*644 la "$.024HJLVXZ\`bdxz|𬒆waK*jShjHQh@I5OJQJU^J*jShjHQh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@I*j RhjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*jQhjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^JZ\bڸ\/PZP* aP aPa $$Ifa$gd@IkdR$$Ifl\)  t00*644 laȸʸ̸ָظڸܸ "$.024HJ⨜waK*jUhjHQh@I5OJQJU^J*jyUhjHQh@I5OJQJU^J*jUhjHQh@I5OJQJU^Jh0Wh@ICJOJQJaJh@ICJOJQJaJh@I)jhb!5OJQJU^JmHnHu*jShjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^Jjh@I5OJQJU^Jڸܸ 2Z\/PZP* aP aPa $$Ifa$gd@IkdpT$$Ifl\)  t00*644 laJLVXZ\^bdxz|ȹʹֹ̹عڹܹ޹ɽwaɽ*jWhjHQh@I5OJQJU^J*jlWhjHQh@I5OJQJU^J*jVhjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J!Z\bڹ\/PZP* aP aPa $$Ifa$gd@IkdaV$$Ifl\)  t00*644 laڹܹ 2Z\/PZP* aP aPa $$Ifa$gd@IkdXX$$Ifl\)  t00*644 la "$.024HJLVXZ\^bdxz|ڷڬڷڬڷ|paڬKڷ*jZhjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*jYhjHQh@I5OJQJU^J*jcYhjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*jXhjHQh@I5OJQJU^JZ\bں\/PZP* aP aPa $$Ifa$gd@IkdOZ$$Ifl\)  t00*644 laȺʺֺ̺غںܺ޺ "$.𬒆waK*jQ]hjHQh@I5OJQJU^J*j\hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I*j[hjHQh@I5OJQJU^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHu*jZ[hjHQh@I5OJQJU^Jh@I5OJQJ^Jjh@I5OJQJU^Jںܺ 2Z\/PZP* aP aPa $$Ifa$gd@IkdF\$$Ifl\)  t00*644 la.024HJLVXZ\^bdxz|Ȼʻ⨜waK*j_hjHQh@I5OJQJU^J*jH_hjHQh@I5OJQJU^J*j^hjHQh@I5OJQJU^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@I)jhb!5OJQJU^JmHnHu*j]hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^Jjh@I5OJQJU^JZ\bڻ\/PZP* aP aPa $$Ifa$gd@Ikd=^$$Ifl\)  t00*644 laʻֻ̻ػڻܻ޻ "$.024HJLVXZ\^bdxɽwaɽ*jahjHQh@I5OJQJU^J*j?ahjHQh@I5OJQJU^J*j`hjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@ICJOJQJaJh@ICJOJQJaJh@IhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J!ڻܻ 2Z\/PZP* aP aPa $$Ifa$gd@Ikd4`$$Ifl\)  t00*644 laZ\bڼ\/PZP* aP aPa $$Ifa$gd@Ikd+b$$Ifl\)  t00*644 laxz|ȼʼּ̼ؼڼܼ޼ڷڬڷڬڷ|xtxfQ)h hW5;>*CJOJQJ^JaJhWCJOJQJ^JaJh+hWh@I*jchjHQh@I5OJQJU^J*j6chjHQh@I5OJQJU^Jh@I5OJQJ^JhjHQh@I5OJQJ^J)jhb!5OJQJU^JmHnHujh@I5OJQJU^J*jbhjHQh@I5OJQJU^Jڼܼ\/TL`'?/&3/& $$Ifa$gdjl $Ifgdjl$a$gdW$a$gd+kd"d$$Ifl\)  t00*644 la<>@BDF/&/&D2fkdd$$Ifs&' t0'44 sa $$Ifa$gdjl $Ifgdjlֽ:<>DFH^`bvxzڷjUGhCRhW5OJQJ^J)jhb!5OJQJU^JmHnHu*jufhCRhW5OJQJU^JhW5OJQJ^JjhW5OJQJU^JhWCJOJQJ^JaJhWCJOJQJ^JaJ h9OhWCJOJQJ^JaJ#hWB*CJOJQJ^JaJph)h`uhWB*CJOJQJ^JaJph h`uhWCJOJQJ^JaJFH\^ {{ $Ifgdjl{kde$$IfsJ0& t0'44 sa^`w6\nan $Ifgdjlkde$$Ifs40&` t0'44 sapw6\nn $Ifgdjlkdf$$Ifs40&  t0'44 sapwt;nan $Ifgdjlkdg$$Ifs40&` t0'44 sap Xp"&pZڷt_M_M_M_M_M_M_M_M_#hWB*CJOJQJ^JaJph)h BhWB*CJOJQJ^JaJph#hWB*CJOJQJ^JaJph)h`uhWB*CJOJQJ^JaJphhWCJOJQJ^JaJhWCJOJQJ^JaJhCRhW5OJQJ^J)jhb!5OJQJU^JmHnHujhW5OJQJU^J*jWhhCRhW5OJQJU^J wt;nn{n{n $Ifgdjlkdh$$Ifs40&  t0'44 sapVXrtv s/&s/&s/&s/&s/&s/&s/&s/&s/&j/&j/& $Ifgdjl$$7$8$H$Ifa$gdjl{kdi$$Ifs80& t0'44 sa \^`b(*,J/&̛`'^}`'x`'is`'in`'in`'illdV$a$gdhgdqgd)sgdJ[M$a$gd+ 7$8$H$gdWhkd6j$$IfsW &' t0'44 sa $Ifgdjl Z\^`b "$&(*,Jȼ{j{j[WSChH^:h:5CJOJQJaJhh:h~th:CJ OJQJaJ !hCJ OJQJaJ mHnHujh:CJ OJQJUaJ %jhqh:CJ OJQJUaJ hqh:CJ OJQJaJ h| h:CJ OJQJaJ h:CJ OJQJaJ h+h_}hW5CJOJQJaJhWCJOJQJ^JaJ)hfhWB*CJOJQJ^JaJphJn ,PVVVVVVVVVVV`'$a$gd+gdn$a$gdngdh$a$gdhJ ,hzh+hRhH^:h:5CJOJQJaJh:h:CJOJQJaJhH^:h:CJOJQJaJ.&P1h:pm"/ =!8"8#$% nJpbQ9PNG  IHDR8-gAMAPLTEU~OIDATxO+q{!+r>t 䐣@?| ,$^^rp/`C;`y!vC@fgRU=3$t q| *ɿɾ 3j ~ 5`Q*飣+MӣݦK#n pqIDrhe젩yXb(icCI e-mlUk {`H]5m-fޢ2'O6jˋr^{z%GӴjq8P1O!u"ސt۶ӻ TоW حO"y%}o!k{4mA{ٟ܎dGG;xCu 0;FKj=d6t3";:zk\ Xָ+how{JgҳwfD8<}oH@ш#0xaꎺ#SG :h]JSA_} ͩCZrzOin)FyTrkRK$ ^ v"ZPZn&Z$y:#)JO:m+cZh@ I7&VL ;RDC u{@ h!!ÂL?mYc:NY5ym`b`zKv:QBfKl-lOdtXh?.Z[ V[^Yrܞ џOd5!T *a"K"2 Jᾇgrn.9%K^ _gR@oG<.7Xu-jݮR}zeq|(.7mn$?C=9pn(%GI5H8=ilh>X#1C͜܆ zy7H;^s@x.;cT3 )h;,'f6'D}-,TsҠ QNžu0w+/kN*nT)2pځDu&hC]6OYTD0e5; E ,qלEz7H"z%=8{)dr;lg[.JrQaOVX'v z%:"><25$k.G4S`DN8L9qDhj>p)Yɑ,9 ]F%o|6R{ƫLe7l.Ox.ؙ+NjI˾iisMs~8\.ԝ/P}} d|^z8_h.RLfW+X'Rfu$Y3l,Ǹ i 8=04XS:+Օȗ"+T+L->V[t sQW43R*У>.j=+WWwrjA:Tsih*&,dmXAsM\6b 4Bf6`*RR3-tɩ#\2pM37-HPRyu``W&9$FI.@FK͑8H-a|9Fylr)cΘ;wH&-%gvO\lfVifK2K4/ ##Mj?,TOC{{$zy s,:ު q`@ ,JK.fgd7\O=jA9#RsēfxFj_sv0`~ffJn>R-d,B'sŃ7AkHyU<]>pFI-f)sYKnD> qN3$\,H=ODtM6"|qő AkXhf rM;$/rZ[*3?ư fQ]VfpCՈ #K\4~U;0Tq"C9Fm>2#k+0p]1Bu!yپp٦ 23.$uYrh칚286$s;5[CEM\s?ʨR^5}pQ>xeXȸPvD\1wn05eO"pGb9Ŕ&# ߘ=737k4ppյX72isn4'J6p]D͟\(n\h\$G7K¸qh).e&/k#W]#G/9u% =hKKc=D+n&ܷ|&zzp A8sd!t{X~O78Ur߲Eɱ\M0A(Z% M$s;hrY [p^4(#%Mx䚷ɚ:pU~ S_RL" r_2dWrmcnɩEw?Wp}eWr@ZrYr759';!;RSI7ymBtMW/^ط_}e1w߉7yvyC%ת(h\ȟ_a=%oBUq&yxK+rrk/CD̑ʪAf{# ;9 LA!+OOOk9s^/̧ʾ^Oo%D8_[\{jTe[UF ׯܦ>L`@_ܑ\q5`LS,~=/qI(h D-enrпos83 &;ir/8+K0f`%=EP! #NSO}A0 1T5dQUmna%9;ï.?E#GpsLS ]rG4瓓!ϩ= VEGQ>D~Q=(\$wmlp)np]~k$ l9ffzCBYq1&鳒Sz2[d~USK߳h^;!4w缁557%n'Bk*'n*)18"!r+|sh츲iR̹˕G==߳jqw#i8.OP]T[Cw=|- 3`l5'4-Ȭ'iOJ|u/:5"Cl]ޮ9ة _9t31جcټH&^4q3RIS7wp-HSjK*jCCAP%SGf|LJ !9M%,. 3ԔTnXBNRA4: ,L~t#)LEqzDQ@Tg'}B0A +s=cOW|'Z؞Ŝ:V,"YWДxL |B_̡ի!@ܾWYCזh]¼=U1Ё JnC1y9*l1š.c}U?ެB\PODf`͝\)OVGj6\>-2q%1CՈ*CG:J]Æ zڡ(:6Ѐᆏ[K*jp4xknB>A?JWG""&]bBN*.Wّ"QN|JGK8Bj2Wn r@);niu$ 죆&HS=6IYFQyl*uAU`G`Ap>(vĺ6S\ť]4: t-ZYB9IYesb49k~(qon}. M/|>Ւ-ѯ= k͇GghnZAߣxut\me6x h#p1Τe>SE:qUB|l 3O9O5!(Iv@HTuQ܈OqyGd&+.c5y6$:8ם)>DQj<(ujP1%y,wPPW*"{]p|Z-RU⟬W)7SY*# tz 2ۓh01d\c WZ/Ϸ  *pgL.!KS:\&pa79UZ`zliCM.zan]P嚰[F\^OA1}_>6 fAfmRLiXvAqv!Ayo!mVKJ/dw 6RhC4D+E [j!wBY(V Ϫ]/= ޫ7|ҽ{O+}uPpP mVi{"ݺxAw/͐7:֐ ٺA{sÍ uc.uǨ{ťo W[J]]9>/F6,:/￟ k]>1wy]Ap:u"8M=taTAGEy% \AJ_ŠI)#7xcޮv$`ALP{p/k67i55@z | TitleL$$d %d &d 'd N O P Q a$ 5CJ \4@4 | Header  !4 @"4 | Footer  !6U@16 h Hyperlink >*B*ph.X@A. hEmphasis6]j@Sj M Table Grid7:V0HbH el Balloon TextCJOJQJ^JaJFV@qF r2FollowedHyperlink >*B* ph.)@. ~t Page NumberZC@Z bBody Text Indent$0^`0a$OJQJ:q:q z z zo9a+,(<=?Sg{|~$89;Ocwxz !569Mauvy !569Mauvy !569Mauvy-.1EYmnq  - . 1 E Y m n q   - . 1 E Y m n q   - . 1 E Y m n q   - . 1 E Y m n q   - . 1 E Y m n q -.1EYmnq-.1EYmnpqs !"#$./0DEFKLMabc9:ow%7OP`n@0@0x@0@0@0@0@0@00@00@0@0@0@0@00@0@0@00@0@0 @0 @0 @0 @0 @0 0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @00@0x@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0x@0@0@0@0 @0 @0@0 @0@0 @0 @0 @0 @0 @0 `0 @0 @0 @0 @0 @0 `0 @0 @0@0 @0@0 @0 @0@0@0@0@0@0@0@0@0@0@0@0 @0 @00x0@0@00@00p@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0x<9+,5u - m q#.:ow@0@0@0@0@0@0@000 $00000 0` @0`00ll00ll00ll00ll0 0ll00ll00ll00ll00ll0 0l 00 t00000 0 0*00*000 00 0 0z0000z00z00z00000000@00A0 @0 dddgn ( b @hXv4x J.x Hڶx J.ʻxZJ"$&(*,/1357:<?@CEGILNPRUWYdgikmortvx{~ | x t pljjjjjjZZZZZZZZڶZڷZڸZڹZںZڻZڼF^J !#%')+-.024689;=>ABDFHJKMOQSTVXZefhjlnpqsuwyz|}  &(4:?KQS_egsy~"$06;GMO[acouz  !-39EKMY_amsy  !-39EKMY_amsy  !-39EKMY_amsy%+1=CEQWYekq}     % + 1 = C E Q W Y e k q }      % + 1 = C E Q W Y e k q }      % + 1 = C E Q W Y e k q }      % + 1 = C E Q W Y e k q }      % + 1 = C E Q W Y e k q } %+1=CEQWYekq}%+1=CEQWYek0<BMY_XFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFMOT_ag!l,b$JpbQ90@D(  |  S LAI.`US`TUS`T\  3 "` \  3 "` \  3 "` \  3 "` B S  ?9:;<t`'t t`'t t/Text1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12Text13Text14Text15Text16Text17Text18Text19Text20Text21Text22Text23Text24Text25Text26Text27Text28Text29Text30Text31Text32Text33Text34Text35Text36Text37Text38Text39Text40Text41Text42Text43Text44Text45Text283Text284)@Th%<Pd{":Nbz":Nb1N  !"#$%&'()*+,-.';Rfz#7Nbv  4L`t  4L`tC`%yD'&y2!'y<3!(y|3!)y*y+y ,y #-y .y#/y,0y=!1y!2y$3y4y 5y&6y'7y8y9yY#:yY#;y4Z#y*urn:schemas-microsoft-com:office:smarttags PostalCode '(;?RSfgz~#$7;NObcvz   !49LM`aty   !49LM`aty   !49LM`aty,1DEXYlq    , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q ,1DEXYlq,1DEXYl0CM`'(;?RSfgz~#$7;NObcvz   !49LM`aty   !49LM`aty   !49LM`aty,1DEXYlq    , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q ,1DEXYlq,1DEXYl0CM`'(;?RSfgz~#$7;NObcvz   !49LM`aty   !49LM`aty   !49LM`aty,1DEXYlq    , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q     , 1 D E X Y l q