| Name | Description | Type | Additional information |
|---|---|---|---|
| EmployerName | string |
Required |
|
| EmployerAddress | string |
Required |
|
| EmployerPhone | string |
Required |
|
| EmployerCity | string |
Required |
|
| EmployerState | string |
Required |
|
| EmployerZip | string |
Required |