Std 21 Compliance Review Page 2

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PART II — CURRENT WORK FORCE BREAKDOWN OF MAIN OFFICE/ORGANIZATION INVOLVED IN
CONTRACT
1.
Total Employes in Establishment
Minority Group Employes
Male
Female
Job
Total
Total
Total
American
American
Categories
Employes
Male
Female
Asian/
Indian/
Asian/
Indian/
Including
Including
Including
Pacific
Alaskan
Pacific
Alaskan
Minorities
Minorities
Minorities
Black
Islander
Native
Hispanic
Black
Islander
Native
Hispanic
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Officials & Managers
Professionals
Technicians
Sales Workers
Office & Clerical
Craftworkers (Skilled)
Operators (Semi-skilled)
Laborers (Unskilled)
Service Workers
TOTALS
Total Employment one
year prior to this report
(TRAINEES BELOW SHOULD ALSO BE INCLUDED IN THE FIGURES FOR THE APPROPRIATE OCCUPATIONAL CATEGORIES ABOVE)
Formal
On-the-Job Trainees
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
White-Collar
Production
2.
Dates of Payroll Period Used (Both dates must be completed.) Weekly, Bi-Weekly or Monthly Only.
/
/
/
/
BEGINNING PERIOD:__________
__________
__________
ENDING PERIOD:___________
________
__________
MONTH
DAY
YEAR
MONTH
DAY
YEAR
_______________________________________________________________________________________________________________________________________________
3.
Will there be a change in the work force as a result of this contract?
À
À
Yes
No
If YES, how many employes do you anticipate hiring?_____________
PART III — PRESIDENT/CHIEF EXECUTIVE OFFICER OR EQUAL EMPLOYMENT OPPORTUNITY OFFICER (Return
the signed original copy.)
Name and Title (Type or print)
Signature
Date
Phone No.
FAX No.
CONTRACTOR SHALL PROMPTLY GRANT ACCESS TO ITS FACILITIES TO AUTHORIZED STATE AGENCY
REPRESENTATIVE(S) FOR REVIEW OF DOCUMENTS, INFORMATION AND INTERVIEWS OF COMPANY
PERSONNEL.

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