Year 2010 temporary budget to make available the ... - Jersey City

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12/19/2005 12:56 FAX 2015416579
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INSTRUCTIONS FOR COMPLET NG THE
EMPLOYEE IN FORMATION Rl:PORT FORM AA302)
JMPORTANT: . .
READ THE FOLLOWING INSTl~UCTlONS CAREFUI.I. Y Ð FORE COMPLETING THE r:ORM.
PRINT OR 1YPC: ALL INFORMATION. FAILURe TO PROPERLY COMPLET THE ENIRE FORM
MAY OSI.A'f ISSUANce OF YOUR ceRTIFICATE IF YOU HAVE! A CVR!NTCE;RilFICATS or
ØflPI.OYëE INFORMATION REPORT,lbO NOT COM~i.E: E THIS FORM. SEND COPY OF
CURR~Ni CERTIFICATE TO THE P.UBUC AGENCY. DO OT OOMPLET.E THIS FORll1 FOR
CONSTRUCTION CONTRACT AWARDS.
.ITEM 1 - F.ntor the f'odi:rú lcantlßoatlci NUl1bCir anslnnlJr, I))'
1M Intemol ROY8nUC Snl\'kn. or If ø r:l,doral Employ.,r
IC:I1nliljøiit/øn Numllr 1\Ø1. h~n iipPIID4 rot. or ir your
bui:lnu~D I' øuch tht yo hov not Or Wlh 1101 recew ø
fodOr11 I:pIOYOl/danllti::titi Numbnr. lnltt tho Socleil
SGcurity Numiir of thli OVinar ar Dr on" parnot. Ii\ Ihl! CGlI
of ø piulner.hlp .
ITEM 2. Chcr li bo :i~proixale to your 'I'PE OF
DualN EUS. If)'l 01' enuaSlnd In moio lhi;n ono tyo cif
hunlnip checIClIo pmdC''l1nClto oric, II you oro ..
m::\lll.c\urf dorlngmClra than tsO% of your l~cDJplii frni
your cwn rCltall oinob, ëh 9ck -.RlitaJl'ò
ITeM S .liricer ih lolAl'rUlnbál" 0' omployoa In IIi entiA!
1".ulilpany.lncldl pa-liina cmployull. ""i~ nl'inbcir MAtt
InclurJu all fAcJlllqa In 1lo ~nt1r-. flrl1 or r.i,oriillan.
ITEM," . (':1110r th9 nM'8 :,y whltii Uia compiny Is IdanOßotl
If U:cro ii mora ih ono c:omp:my nanlO, cntt!ilhe
procfomlniite ono. .
ITEM tJ - E!ntl!t dIG pnY$IC:311C1a:lion cd itl; ~/'l'y. InclUde
CIty, County. $llo and ZIJ) Codu.
ITEM G . I:,;tet lha niimei' any puront or alllll1llJ company
Inciuding 11'8 Cit, County. siale and Z1~ Code. If tho iø
IIOIlg. 110 Indcoto by onlltilng .NÐno~ or NlA.
ITEM 7 -Chock 1111 bo)C ClpPprl~to to your typo 01 COI1PQI')'
eslabtlshmonL .Slilo-tabllølienC Empløyol" shall Indudo.
lin omploYEt y,l()G bualn.2Do 10 condUcted Ðt only orio
phyøfci:l locallan i.u1tJ$tallhmøni Eniplo)'(' shall
Indldo Pr1 employr Wll':,o bU&IMS~ Is conducld a' mON'
Ihti anD IClCDlIn.
llEM 8 .Ir "MUII.88lllDJliihmoni" we. øntlil' 11' Ilem Ð. f1nlnr
tho num!?or ololtab\hl1lmtl Wlthln tho 8tute or lI(\w Jersoy.
.
ITeM 9 .. Enlor Ihe 10101 number of oipJoyeo~ at thO
4):tibllhI'IOrilbolnø øwar:fadlll$ CONtAct
ITeM 10 w Enlotho name of tho PubloAgoricy IiWArclll,g thCl
conuøcL fnduo Ci)', Coty. ~lRte and Zip Co~e.
TYPE OR PJ\INTIN SHARP BAloL PO
tTl\, 11 "t:nt r iho iippropi1alo f1qureR on all hnor¡ Rnc In all
colur'I. nil SHALL ONI. Y INCLUDE EMPLOYMeNT
DATA rn.OM lit: FACILIl Y '.HA T iS BEING I\WARDEU
THE CON li CT. 00 NO" lI:1t Ih IIIJ omplayoo In mOnt
Uian ono Job ~l"Dor. DO NOT Oliui, an ev.C)1 Report.
. R:lQJlUSthnl Groups win bo defli'od;
Diiiok: Nui.al l,pAlile gtlgln. Pør:iQl0 hGvli'll c:tloln In Bny 01
Iho Btncl nid I grouJ'1l of ,A.frlca
Hlllpanlc;: Po llOnA of MGXI"'''''. P\orto Rloo, Cuban. or
ClJl1lralor Sa Ut Arli~llcõ2n or olhnrSpanlSh culturo or orloln.
roøIUIIC1l1" of 8CQ .
Amorlclllln Ian ørAI~'GI(.n NAt/VO: poraoni h&'Vinn oilalri:;
iii any at Ut itllial p~'Opla:a ::f NOt\h MtU"=' anc who
ma1ntnln cilh rilldenitnootlon through lral arriUllticin nr
c:mmunll) iuon.
Alllnn 0" Pao tic l:aliiider: f1"rIQO~ tinvJra orialn In Rnv nr
'he orllngl opki:o 01 U10 r'ar rb So~ltho:GtAGilt. th:i
Indloo Sult.c nl,""n' ot dWi f'uciOc InlanCls. TI\16 cirOQ
InclucQ3 for :ipl", China. Japan.l(. the Phillpplnl1
laloml. and Qftn4.
Noii.flnad : Nt I'artian: not Idlil\llIad In:iny 0' lhet
li(0oiltunU R(ld:JIJIhIIG Groupe.
ITl., 12 . C eck U1(' AIJPropriaie bOle II the race or ethnl .
uraup Inrm Uon WO!' ~Q1 obtDlnod ii 1 or 2. Ri'ecil) by what
otht means Ill WÕS done In 3. .
ITEM 13 . r. r thii d:ilg!l of chit piioD parfod iiicr! to
pr.ipMo (ho ' ploymon\ dabs proionled In tlom 12.
'Yo,". .
IT5M 14.1f hlt It thea f1rn\ Urre .nEinplOyQ Infori;iUc
Report hui: submitted far thin c:mpany. chock bloc
ITEM 16 -If he anawt tn I'om 15 Ì$ "No., ~ the data
when th Ji Iimployee lnronnl2lan RopOlt wan DUbmlt by
this cop~." .
ITEM 1 0 . P nt or ty U'l nalCl of Iho peiMn completll1
ih fOr, In ucl tho a'gnaturv, IIUC en dat.
IT1M , T . E lor 110 PhYDlcal'loc:itlri IIOl' the form Is boll\ø
cipJclad, .1 lude eii" Slate. ZI COdo and Phane Numbar,
'IHli VßNDOIUS 10 COMi'ura 1HEMl'L()Yrii JN1ioRMi\ nON moaT f"Olt (A303) AND RBTAIW COPY FOJl111R
V~l,OJ~'S OWN JlfLt!S. .;116 VEDOR. IS l'U !l"tJDMI'r A COpy TO nm PU9UC OSNCY AWARD1NO nIl CONTJCT AND
:Fan-WAItO A COI'Y Tn
NJ Pepin11oat of.thTrn'l
Ðfveiloii ofColitncl Complliini:e & teClIIRIBIlJlO iient Oiiii,,"qnlty
'.' P,o. Jox,Z09
'llGn, Nqw JatUay al.i~2.08 : Tal phono No. (108) =11.8478
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