Florida Wages And Payrolls Forms & Documents (Page 6 of 13) in pdf

Form 700-010-63

State of Florida, Dept. of Transportation

EMPLOYEE INTERVIEW FORM-labor/eeo

Construction

01/11

"Confidential: All information in this form shall remain confidential to the extent permitted by law, including Florida Statutes Chapter 119"

RCS’S PROJECT IDENTIFICATION

A -

IDENTITY DATA SUPPLIED BY EMPLOYEE

Section

first &

Fin. Project #

last name

F.A.P. #

Contract

1. Employee



signature

Prime Contractor

Section B

2. Employed by:

INTERVIEWER’S IDENTIFICATIO

4 digit ID

3. Social Security No.

Or Full No.

first & last

4. How Long with company?

name

Interviewer



signature

5. How Long on this

project?

Male

Female

F. Interviewer’s Employer

6. Employee Sex

 White

 Black Hispanic

7. Employee Race

 Am Ind/Al  Asian  2/+races

G. Date of Interview

 Native Hawaiian/P. Islander

INTERVIEWER’S OBSERVATION

2-JOB & PAY DATA SUPPLIED BY EMPLOYEE

C-

Section

H. Describe employee’s

8. What have you worked on today?

work at time of interview

 No

9. What tools are you using today?

I. Name hand tools the

 No Tools

Tools

employee was using

 No

10. Are you running any equipment

J. Name of equipment

 No Equip

Equip

today?

employee was operating

11. What is your job or position?

K. What is the proper

classification for this

work?

12. How much are you paid an hour?

$ ___ . ___

 No

Yes

(

)

Optional 2

observation same day

Observ

13. Are you paid every week?

L. Was 2

Observation of work, tools &

Yes No

If No provide following:

equipment same as previous?

14.Do you get extra money if you work over 40

M. Describe employee’s

Yes No

hours? How much?

Work at time of 2

Observation/

15. Did the company pay for your hardhat, vest?

Yes No

16. Is money taken from your check for

N. Tools used

Yes No

 No

Insurance, loans, uniforms, child support etc?

Tools

17. Were you told to give someone money o

Yes No

favors to get this job? Or to keep your job?

O. Equipment operated

 No

Equip

EEO DATA SUPPLIED BY EMPLOYEE

Section

P. What is the proper

classification for this

18. Are the company’s buildings and service open

Yes No

work?

to everyone no matter their race or sex?

RCS’ REVIEW & ACTION

19. Do you feel discriminated against because of

D-

Yes No

Section

your race or sex? Treated differently?

20. Who is your company’s EEO Officer?

first & last name

Date of RCS review

Yes No

RCS

As shown

Classification

Rate Paid

Fringe Paid

21. Have you seen the project bulletin board with

Yes No

on Payroll

PAYROLL

the wage and job posters?

VESUS

Rate Min

Fringe Min

22. Have you been asked to bring people in to

Yes No

WD MIN.

WD FOR THIS PAYROLL CLASSIF

to apply for a job?

RATE &

FRINGE

WD FOR CLASSIF IN “K & P”

Rate Min

Fringe Min

4-FRINGE

DATA SUPPLIED BY EMPLOYEE

Section



same as WD for payroll classif

IF FRINGE IS REQUIRED,



Cash

Benefits

Combination

23.

Are you paid for holidays, sick days, vacation

Yes No

HOW ARE FRINGES PAID?

Yes No

24. Does the company pay any of your insurance?

S. Is there a discrepancy between work, tools

Yes No

equipment, classification, rate paid or fringes?

25. Interviewer comments/exp

see attached none

Yes No

T. Any concerns from Sections 2 or 3?

U. RCS Comments

see attached none

Florida Wages And Payrolls Forms & Documents Page 6

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