Affidavit of Employment Template - Excel by hza15072

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									                                   ELECTRONIC INSTRUCTIONS
                        2007-2008 COMMON CONSTRUCTION WAGE SURVEY
              PLEASE READ THE INSTRUCTIONS CAREFULLY AND NOTE THE FOLLOWING:
l All Survey forms must be received by October 1, 2007.
l Survey responses that are incomplete or illegible may be excluded.
l Use a separate line on the survey form for each entry. You may duplicate the form as needed. For more information, visit
  the agency's website at http://www.in.gov/dwd/employers/comwage_index.html.
l Information that cannot be verified will be rejected.
l Submit your completed survey with contact information and signed Affidavit, by e-mail to: commonwage@prairiequest.com.

                                                Select the job classification code from the listing below that most closely
             JOB CLASSIFICATION
            CODE
                                                describes the type of work being performed. Please consider only the actual
                                                work performed rather than the job title or other affiliations.
                                                An individual who performs work in a classification listed on the scale of wages.
                                                It shall be presumed that an employee is a skilled worker in that classification,
                       Skilled                  and entitled to receive compensation at the skilled rate, unless the worker
                                                satisfies all of the criteria for being categorized as a semi-skilled or unskilled
                                                worker.
                                                An individual registered in a bona fide apprenticeship program registered with the
                                                United States Department of Labor, Employment and Training Administration,
            CLASS     Semi-skilled             Bureau of Apprenticeship and Training. Apprentices are paid pursuant to their
                                                individually warranted percentage for the classification of work that they perform
                                                as set forth in the apprentice program standards.
                                                An individual with less than twelve months of cumulative experience in the
                       Unskilled                construction trades and who is not registered in a bona fide apprenticeship
                                                program.
                                                The dollar amount you paid Indiana employees working in Indiana per hour
                                                working in this classification at this skill level. If you paid various wages, please
            BASE RATE PER HOUR
                                                use the mode wage. For example: 1, 1, 1, 1, 1, 2, 3, 4, 5….1000. The mode is
                                                “1” because it is the number that appears most.
                                                Fringe Benefits are paid in addition to the hourly rate. Report only the costs or
             FRINGE BENEFITS RATE               contributions incurred by your company, NOT the employees. Do not include
            PER HOUR                           costs paid by the employer that are required by Federal, State, or local law such
                                                as worker's compensation or unemployment insurance.
                                                Number of man hours worked in this classification at this skill level for wages
            NUMBER OF MAN HOURS                reported in Box 3. Please only include hours for employees living and working in
                                                Indiana.
             COUNTY WHERE WORK                  Please indicate the county where the work was performed for the hours listed in
            PERFORMED                          Box 5.

JOB CODE     JOB CLASSIFICATION                               JOB CODE      JOB CLASSIFICATION
  47-2011    Boilermaker                                        47-2132     Insulation Workers, Mechanical
  47-2021    Brick Masons, Block Masons, & Pointers             47-2141     Painters, Construction & Maintenance
  47-2022    Stone Masons                                       47-2142     Paperhangers
  47-2031    Carpenters                                         47-2151     Pipelayers
  47-2041    Carpet Installer                                   47-2152     Plumbers/Pipe, Steam, & Sprinkler Fitters
  47-2042    Floor Layers, Except Carpet, Wood & Hard Tiles     47-2161     Plasterers & Stucco Masons
  47-2043    Floor Sanders & Finishers                          47-2171     Reinforcing Iron & Rebar Workers
 47-2044.2   Tile & Marble Setters                              47-2181     Roofers
 47-2044.3   Tile & Marble Finishers                            47-2211     Sheet Metal Workers
  47-2051    Cement Masons & Concrete Finishers                 47-2221     Structural Iron & Steel Workers
  47-2053    Terrazzo Workers & Finishers                       47-4011     Construction & Building Inspectors
  47-2061    Construction Laborers                              47-4021     Elevator Installers & Repairers
  47-2071    Paving, Surfacing, and Tamping Equipment           47-4031     Fence Erectors
             Operators
 47-2072     Pile-Driver Operators                              47-4041     Hazardous Materials Removal Workers
 47-2073     Operating Engineers & Other Construction           49-2022     Sound & Communication Worker
             Equipment Operators
 47-2081     Drywall Installers & Ceiling Tile Installers       49-9044     Millwrights
 47-2082     Drywall Finishers/Tapers                           53-3032     Truck Drivers, Heavy and Tractor-Trailer
 47-2111     Electricians                                       53-3033     Truck Drivers, Light or Delivery Services
 47-2121     Glaziers                                           53-7021     Crane & Tower Operators
 47-2131     Insulation Workers, Floor, Ceiling & Wall
                                        ELECTRONIC INSTRUCTIONS
                             2007-2008 COMMON CONSTRUCTION WAGE SURVEY
                   PLEASE READ THE INSTRUCTIONS CAREFULLY AND NOTE THE FOLLOWING:


 STEPS    FIELD NAME                  FIELD DESCRIPTION                                  FORMATTING EXAMPLES

                                      Enter I.D. # from the paper survey. If you do
                                      not have your paper survey or can not locate the
                                      I.D. # - please e-mail your request for ID # along
                                                                                         Numeric 5 digit field.
 STEP 1   I.D. #                      with your company name and telephone # to
                                                                                         [10000]
                                      commonwage@prairiequest.com,
                                      THIS NUMBER IS REQUIRED TO SUBMIT
                                      ELECTRONICALLY.
                                                                                         Numeric and Text field.
 STEP 2   E-MAIL ADDRESS              Enter the main contact's E-MAIL ADDRESS .
                                                                                         [sdonaldson@compname.com]

 STEP 3

                                      Choose from the drop down menu JOB                 Drop down menu.
         JOB CLASSIFICATION CODE
                                      CLASSIFICATION CODE .                              [47-2011]

                                      Choose from the drop down menu CLASS               Drop down menu.
         CLASS
                                      (Skilled, Semi-skilled, Unskilled).                [Skilled]
                                      BASE RATE PER HOUR is the dollar amount
                                                                                         Enter in as currency.
         BASE RATE PER HOUR          paid hourly. This does not include any Fringe
                                                                                         [$8.50]
                                      Benefits.
                                      FRINGE BENEFITS RATE PER HOUR is the
                                      dollar amount paid hourly for Fringe Benefits
          FRINGE BENEFITS RATE        only. This does not include the Base Rate Per      Enter in as currency.
         PER HOUR                    Hour. The Fringe Benefits Rate Per Hour            [$3.20]
                                      should be less than the BASE RATE PER
                                      HOUR.
                                      Total NUMBER OF MAN HOURS worked                   Enter in numerically.
         NUMBER OF MAN HOURS
                                      between 6/1/2007 and 8/31/2007.                    [120.00 or 120.50]

          COUNTY WHERE WORK           Choose from the drop down menu the COUNTY Drop down menu.
         PERFORMED                   WHERE WORK PERFORMED .                    [Indianapolis]

 STEP 4


AFFIDAVIT SHOULD BE FAXED, SCANNED AND EMAILED, OR MAILED WITH SIGNATURE TO:

              COMMON CONSTRUCTION WAGE
              1830 WAYNE TRACE, SUITE 6
              FORT WAYNE, IN 46803

              FAX: (260) 424-0024
              EMAIL: COMMONWAGE@PRAIRIEQUEST.COM
                                                     STATE OF INDIANA
                                    DEPARTMENT OF WORKFORCE DEVELOPMENT                                   ID #
                                                1830 WAYNE TRACE, SUITE 6                                            DATE RECEIVED:
                                                   FORT WAYNE, IN 46803

                                              ELECTRONIC SURVEY                                                      FOR OFFICE USE ONLY


                                    2007-2008 COMMON CONSTRUCTION WAGE
                                      FOR WORKED PERFORMED FROM 6/1/2007 TO 8/31/2007
PLEASE NOTE: Completed surveys must be received by Prairie Quest Consulting by October 1, 2007. Illegible or incomplete
forms may be excluded. Please read the instructions before completing the survey. In order to validate your wage information,
be sure to print out and sign the Affidavit. Once signed, mail to: State of Indiana, Common Construction Wage, 1830 Wayne
Trace, Suite 6, Fort Wayne, IN 46803.

            E-mail
          Address:

                                                                                                            
Job Classification                           Base Rate          Fringe Benefits Rate         Number of           County Where Work
      Code               Class               Per Hour                Per Hour                Man Hours                Performed
47-2152            Skilled                           $28.35                   $12.56                             St Joseph
47-2152            Semi-skilled                      $21.25                   $12.56                             St Joseph
47-2152            Unskilled                         $12.75                   $12.56                             St Joseph

47-2152              Skilled                           $28.35                  $12.56                            Marshall
47-2152              Semi-skilled                      $21.25                  $12.56                            Marshall
47-2152              Unskilled                         $12.75                  $12.56                            Marshall

47-2152              Skilled                           $28.35                  $12.56                            Starke
47-2152              Semi-skilled                      $21.25                  $12.56                            Starke
47-2152              Unskilled                         $12.75                  $12.56                            Starke

47-2152              Skilled                           $28.35                  $12.56                            Fulton
47-2152              Semi-skilled                      $21.25                  $12.56                            Fulton
47-2152              Unskilled                         $12.75                  $12.56                            Fulton

47-2152              Skilled                           $28.35                  $12.56                            Cass
47-2152              Semi-skilled                      $21.25                  $12.56                            Cass
47-2152              Unskilled                         $12.75                  $12.56                            Cass

47-2152              Skilled                           $28.35                  $12.56                            Pulaski
47-2152              Semi-skilled                      $21.25                  $12.56                            Pulaski
47-2152              Unskilled                         $12.75                  $12.56                            Pulaski

47-2152              Skilled                           $28.35                  $12.56                            Miami
47-2152              Semi-skilled                      $21.25                  $12.56                            Miami
47-2152              Unskilled                         $12.75                  $12.56                            Miami
                                                                                   
Job Classification                   Base Rate   Fringe Benefits Rate       Number of   County Where Work
      Code               Class       Per Hour         Per Hour              Man Hours       Performed

								
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