Employee Interview Form - Labor
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4700-010-63
CONSTRUCTION
04/15
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
EMPLOYEE INTERVIEW FORM-LABOR
“Confidential: All information in this form shall remain confidential to the extent permitted by law, including Florida Statutes Chapter 119”
Section A – RCS’S PROJECT IDENTIFICATION
A.
Fin. Project #
B.
F.A.P. #
C.
Contract #
D.
Prime
Section B - INTERVIEWER’S IDENTIFICATION
E.
Interviewer
First & Last Name (print)
Signature
F.
Interviewer’s Employer
G.
Date of Interview
Section 1 - IDENTITY DATA SUPPLIED BY EMPLOYEE
1.
Employee
First & Last Name
Signature
2.
Employee ID or last four of SS No.
3.
Employed by
4.
How long with the company?
5.
How long on this project?
6.
Employee Sex
Male
Female
7.
Employee Race
White
Black
Hispanic
Am Ind/Al
Asian
2/+races
Native Hi./P. Islander
Section 2 - JOB & PAY DATA SUPPLIED BY EMPLOYEE
8.
What is your job or position?
9.
How much are you paid an hour?
$
10.
Are you paid every week?
Yes
No
11.
Do you receive time and ½ for hours worked over 40?
Yes
No
12.
Did the company pay for your hardhat, vest?
Yes
No
13.
Have you seen the project bulletin board with the wage and job posters?
Yes
No
14.
Were you told to give someone money or favors to get this job? Or to keep your job?
Yes
No
Section 3 - DEDUCTION DATA SUPPLIED BY EMPLOYEE
15. Is money taken from your check for Insurance, loans, uniforms, child support etc?
Taxes
Repayments
Insurance
Credit Card Charges
Charitable Contributions
401K
Per Diem
Direct Deposits
Uniform
Company Purchases
Union Fees & Dues
Travel
Safety Equipment
Transportation
Loan/Advances
Alimony
Other
Child Support
Stock
Section 4 - FRINGE DATA SUPPLIED BY EMPLOYEE
16.
Are you paid for holidays, sick days, vacation?
Yes
No
17.
Does the company pay any of your insurance?
Yes
No
18.
Employee comments/explanations
Over
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