Initial Project Workforce Report Construction (Form AA-201

Description

Official Use Only STATE OF NEW JERSEY Assignment DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT CONSTRUCTION EEO COMPLIANCE MONITORING PROGRAM Code FORM AA-201 INITIAL PROJECT WORKFORCE REPORT CONSTRUCTION Revised 11/11 For instructions on completing the form, go to: http://www.state.nj.us/treasury/contract_compliance/pdf/aa201ins.pdf 1. FID NUMBER 2. CONTRACTOR ID NUMBER 3. NAME AND ADDRESS OF PRIME CONTRACTO R (Name) CONTRACT NUMBER (Street Address) (City) (State) DATE OF AWARD DOLLAR AMOUNT OF AWARD 7. PROJECT NUMBER 6. NAME AND ADDRESS OF PROJECT Name: Address: (Zip Code) 8. IS THIS PROJECT COVERED BY A PROJEC 4. IS THIS COMPANY MINORITY OWNED [ ] OR WOMAN OWNED [ ] 9. 5. NAME AND ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT Name: Address: TRADE OR CRAFT LABOR AGREEMENT (PLA)? YES COUNTY PROJECTED TOTAL EMPLOYEES PROJECTED MINORITY EMPLOYEES PROJECTED PROJECTED MALE MALE PHASE - IN COMPLETION DATE DATE J FEMALE AP J AP J FEMALE AP J AP 1. ASBESTOS WORKER 2. BRICKLAYER OR MASON 3. CARPENTER 4. ELECTRICIAN 5. GLAZIER 6. HVAC MECHANIC 7. IRONWORKER 8. OPERATING ENGINEER 9. PAINTER 10. PLUMBER 11. ROOFER 12. SHEET METAL WORKER 13. SPRINKLER FITTER 14. STEAMFITTER 15. SURVEYOR 16. TILER 17. TRUCK DRIVER 18. LABORER 19. OTHER 20. OTHER I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements are willfully false, I am subject to punishment. (Signature) 10. (Please Print Your Name) (Area Code) (Telephone Number) (Title) (Ext.) (Date) O N