Form Occ/lw-6 (Rev. 6/16) - Lwo - Employee Information Form

Download a blank fillable Form Occ/lw-6 (Rev. 6/16) - Lwo - Employee Information Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Occ/lw-6 (Rev. 6/16) - Lwo - Employee Information Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

LW-6
LWO – EMPLOYEE INFORMATION FORM
REQUIRED DOCUMENTATION FOR ALL CONTRACTS SUBJECT TO LWO
This form must be submitted to the AWARDING DEPARTMENT within 30 DAYS of contract
execution.
INCOMPLETE SUBMISSIONS WILL BE RETURNED.
THE LIVING WAGE ORDINANCE (LWO) REQUIRES THAT SUBJECT EMPLOYERS PROVIDE TO
EMPLOYEES:
As of July 1, 2016 a wage of at least
$11.27 per hour with health benefits
of $1.25 per hour, or
$12.52 per hour
without health benefits
(to be adjusted annually on July 1) (Regulation #4);
At least
12 compensated days off per year
for sick leave, vacation or personal necessity at the employee’s request
(pro-rated for part-time employees) (Regulation #4); and
At least
10 additional days off per year of uncompensated time off
for personal or immediate illness only (pro-rated
for part-time employees) (Regulation #4). Refer to the LWO Rules and Regulations, available from the Department
of Public Works, Bureau of Contract Administration, Office of Contract Compliance (OCC) website, for details
regarding the wage and benefit requirements of the Ordinance.
Making
less than $12.00 per hour
information of their possible
right to the federal Earned Income Tax Credit (EITC)
and make available the forms required to secure advance EITC payments from the employer (Regulation #4).
THE LIVING WAGE ORDINANCE (LWO) ALSO REQUIRES EMPLOYERS:
Not to retaliate
against any employee claiming non-compliance with the provisions of these Ordinances and to
comply with federal law
prohibiting retaliation for union organizing (Regulation #4).
TO BE FILLED OUT BY THE CONTRACTOR:
1. Company Name: ______________________________________ Email Address:
2. STATE the number of employees working ON THIS CITY CONTRACT: ___________
st
3. ATTACH a copy of your company’s 1
PAYROLL under THIS CITY CONTRACT.
4. INDICATE (highlight, underline) on the payroll which employees are working ON THIS CITY CONTRACT.
5. Do you provide health benefits (such as medical, dental, vision, mental health, and disability insurance)
to your employees?
Yes
No
If YES, STATE how much, if any, employees pay for co-premiums: $_______________
FAILURE TO COMPLY WITH THESE REQUIREMENTS WILL RESULT IN WITHHOLDING OF PAYMENTS BY THE
CITY CONTROLLER, OR A RECOMMENDATION TO THE AWARDING AUTHORITY FOR CONTRACT TERMINATION.
ALL INFORMATION SUBMITTED IS SUBJECT TO VERIFICATION, AND FALSE INFORMATION MAY RESULT IN
CONTRACT TERMINATION.
I understand that the employee information provided herein is confidential and will be used by the City of Los Angeles,
Office of Contract Compliance for the purpose of monitoring the Living Wage Ordinance.
Print Name of Person Completing This Form
Signature of Person Completing This Form
Title
Phone #
Date
AWARDING DEPARTMENT USE ONLY:
Dept: _____________ Dept Contact: _______________________ Contact Phone: _________________Contract #: ____________
OFFICE OF CONTRACT COMPLIANCE, EEOE SECTION: (213) 847-2625
Form OCC/LW-6, Rev. 6/16

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go