Form Erd 10880 - Request To Employ Subjourneyperson - Department Of Workforce Development - 2004

State of Wisconsin

Request To Employ Subjourneyperson

Department of Workforce Development

Equal Rights Division

Labor Standards Bureau

Personal information you provide may be used for secondary purposes. [See Section 15.04(1)(m), Wisconsin Statutes for details.] The use of this form is mandatory. The authority

for the use of this form is prescribed in Section DWD 290.025, Wisconsin Administrative Code. The penalty for failing to complete this form is prescribed in Section 103.005(12),

Wisconsin Statutes.

The employer indicated below requests that the Department of Workforce Development (DWD) determine the prevailing wage rate(s) and related qualifications to

enable such employer to utilize a subjourneyperson(s) on the following public works project, in accordance with the provisions of Section DWD 290.025,

Wisconsin Administrative Code.

1. Name of Public Works Project

County

City, Village or Township

Determination Number

Project Number

2. Name of Employee (Last, First and Initial)

P.O. Box or Street Address

City

State

Zip Code

Date of Birth

Journey Classification

3. Name of Employer (Print)

Name of Person Making Request (Print)

P O Box or Street Address

City

State

Zip Code

Telephone Number

Title of Requestor

(

)

READ CAREFULLY: I fully understand that this request is ONLY applicable to the project and employee(s) listed above and that such employee(s) will ONLY

work under the direction of and directly assist a skilled trades employee by frequently using the tools of a skilled trades employee and will NOT regularly perform

the duties of a general laborer, heavy equipment operator or truck driver. If the employee(s) indicated above regularly perform(s) the work of a different trade or

occupation, he/she will be compensated for such work at the applicable journeypersons prevailing wage rate. I agree not to employ any employee as a

subjourneyperson on this project until I receive written confirmation from the DWD. After such confirmation is received, I will compensate the employee(s)

indicated above in strict accordance with the directions received from the DWD.

Signature of Requestor ________________________________________________ Date Signed ________________________

MAIL COMPLETED REQUEST TO Equal Rights Division, Labor Standards Bureau, P. O. Box 8928 Madison WI 53708.

You may call (608) 266-6860 if you need assistance in completing your request

ERD 10880 (R. 10/2004)