Fillable Printable Employee Interview Form - Florida
Fillable Printable Employee Interview Form - Florida
Employee Interview Form - Florida
700-010-63
CONSTRUCTION
04/15
STATE OF FLORIDA DEPARTMEN T OF TRANSPOR TATION
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. Interviewe
r
First & Last Name (print)
Signature
F. Interviewer’s Employe
r
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 b y
4. How long with the co mpany?
5. How long on this project?
6. Employee Sex Male Female
7. Employee Race White Black Hispanic
A
m Ind/Al
A
sian 2/+races Native Hi./P. Islande
r
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 e very week? Yes No
11. Do you receive time and ½ for hours w o rked 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 Compan y Pur chases Union Fees & Dues
Travel Safety Equipment Transportation
Loan/Advances Alimony Other
Child Support Stock
Section 4 - FRINGE DAT A SUPPLIED BY EMPLOYEE
16. Are you paid for holidays, sick days, vacation? Yes No
17. Does the company pay an y of your insuran ce? Yes No
18. Employee comments/explanations
Ove
r
700-010-63
CONSTRUCTION
04/15
STATE OF FLORIDA DEPARTMEN T OF TRANSPOR TATION
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 C - INTERVIEWER’S OBSERV ATION
H. Describe employee’s work you observed at time of interview.
I. List/describ e the tools/equ ipment the empl oyee was using/operatin g.
No Tools No Equip
J.
Interviewer Comments
Section D
–
RCS’ REVIEW & ACTION
K. RCS
First & Last Name
Date
L. Payroll vs. Wage Determination Minimum Rate and Fringe
As shown on Payroll: As indicated in observation (“H” and “I”):
Classification
Classification
Rate Paid
Fringe Paid
Total
Rate Minimum
Fringe Minimum
Total
WD Rate
WD Fringe
WD Total
Is the classification shown on the payroll equal to or greater than
the classification as observ ed (“H” and “I”)?
Yes No
If Fringe Benefit s are required, how are they paid to the employee? NA – not required Cash Benefits Combination
M.
Are there any discrepancies between work observed, too ls an d equipment u sed, classification and rate of pay?
Yes No If yes, please explain.
Discrepanc y: Was a payroll violation issued?
Improper Classification Yes Code #
Wages paid No
Not Listed on p ayroll
Other:
N. Any concerns from Section 2 or 3?
Yes No
O. Comments N/A
P. Payroll Correction received if applicable:
Date
700-010-63
CONSTRUCTION
04/15
STATE OF FLORIDA DEPARTMEN T OF TRANSPOR TATION
EMPLOYEE INTERVIEW FORM-LABOR
“Confidential: All information in this form shall remain confidential to the extent permitted by law, including Florida Statutes Chapter 119”
GENERAL
This form consist of 2 pages. Because it sho uld be signed by the employee and to make sure that the
pages are not intermingled with pages from other interviews, we recommend that this form be printed
double-sided.
Data is collected by observing and communicating with project workers and it is recorded on this form to
assist in determining EEO and payroll compliance.
The Interviewer records data collected from the employee in Sections 1, 2, 3 & 4
The interviewer complet es S ection B
The interviewer completes Section C ba sed o n the work observed the employee performing
Section A & Section D is completed by the RCS
RCS Completes
Sect. A+D
Interviewer records
Data collected from
Employee (Sect 1+2+3+4) Interviewer completes
B+C
Information recorded on th e Employee Interview Form is to be kept confidentia l and separate from
standard Compliance program records.
DIRECTIONS FOR COMPLETING FO RM
Section A- PROJECT IDENTITY SUPPLIED BY RCS
The RCS completes this section b efore giving the form to the Interviewer. Note that these items can be
filled in on the computer when the form is downloade d
A. Financial Project No. – The Flo rida Departm ent of Transp ortation’s Financial Project Number
B. F.A.P. Number – The Federal Aid Project Number assigned to federally funded projects
C. Contract Number- FDOT contract nu mber
D. Prime Contractor-
Name of Prime
Section B-INTERVIEWER’S IDENTIFICATION
This is the first section that the Interviewer completes
E. Interviewer’s Name and signature
F. Interviewers’ Employer: FDOT or CCEI firm on the project
G. Date of interview: Month/Day /year
Section 1- IDENTITY DATA SUPPLIED BY EMPLOYEE
The interviewer records the answers supplied by the employee
1. Employee: Print first and last name & have employ ee sign below their name.
2. Employee Identification number or last four of Social Security number.
3. Employed by: name of the contractor or temporary agency the employee is working for.
4. How long with Company? Months and/or years employee has worked for company
5. How long on this project? Months a nd or years employee has wo rked on this project.
6. Employee Sex: Record male or female
7. Employee Race: Record the race which the employee identifies with
EMPLOYEE INTERVIEW FORM
Section 1
Section A
Section B
Section 2
Section C
Section 3
Section D
Section 4
Section D
700-010-63
CONSTRUCTION
04/15
STATE OF FLORIDA DEPARTMEN T OF TRANSPOR TATION
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 2- JOB & PAY DATA SUPPLIED BY EMPL OYEE
The interviewer records the answers supplied by the employee
8. – 14. Enter Employee Response
Section 3- EEO DATA SUPPLIED BY EMPLOYEE
The interviewer records the answers supplied by the employee.
15. Enter Employee Response
Section 4- FRINGE DATA SUPPLIED BY EMPLOYEE
The interviewer records the answers supplied by the employee.
16. – 18. Enter Employee Response
Section C-INTERVIEWER’S OBSERVATION
The Interviewer completes this section before speaking with the em ployee and before performing the
interview. The data provided is based on what the interviewer observes just prior to the interview
H. Describe t he work observed at the time of the interview (e.g. digging trench for placement of pipe)
I. List/describe the tools/equipment the employee was using/operating. OR mark ‘No Equi p’ or ‘No Tools’
if none were used.
J. Interviewer Comments
The interviewer’s work is now complete and the form should be turned into the Resident Complian ce
Specialist.
Section D- RCS’S REVIEW & ACTION
K. RCS’s Name and date of review.
L. Payroll versus Wage Determination (‘WD) Minimum Rate and Fringe:
AS SHOWN ON PAYROLL: Review the certified payroll for the week that includes the date
shown in box G (Date of Interview). Record the payroll’s classification, Rate paid, Fringe paid a nd
Total as well as the Wage Determination Rate, Fringe and Total.
AS INDICATED IN OBSERVATION (‘ H’): Review the work/equipment described in ‘H’ and list the
appropriate classification, rate minimum, fringe minimum and total.
Indicate whet her the classification shown on the payroll is equal to or greater than the
classification as observed (‘H’ & ‘I’).
IF FRINGE IS REQUIRED, HOW ARE THEY PAID? Indicate if the employee receives cash,
benefits or some
combination if fringe is required. If fringe is not requi red, mark NA
M. Are there any discrepancies bet ween work, tools and equipment used, classification, rate paid or
fringes? If yes, please explain by selecting the discrepancy. If the discrepan cy warra nts a payroll
violation, indicate the appropriate code or check no if a payroll violation is not required.
N. Any Concerns from Sections 2 or 3? Do the employee comments indicate any concerns f or the RCS: If
so, mark Yes and add comments as noted in box O.
O. RCS comments or mark NA or in dicate date Interview Letter was issued.
P. Enter Date payroll was corrected.
