Homak Intake
Statement of Incident
Store 34994
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Full name *
Current job title *
Current duties *
Date started with McDonald's *
Date started at current location *
Please write the facts as you witnessed them, including Who, What, When, Where, Why, and How. Write in the first person ("I saw", "I did", "I heard", "I spoke to"). *
Print name (serves as your signature) *
Dated *
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