帮忙看看这个怎么填写

bjsac

联盟补发支票 让额填写一个表格：
I, _____________________________, understand that check # _____________ dated ______________, in the amount of $_____________ was mailed to me in payment of work at ______________________________ on week ending _______________ for __________ hours.


on week ending _______________ for __________ hours. 这个位置填写什么？