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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 275-021-21 CONTRACTOR'S RECRUITMENT REPORT EQUAL OPPORTUNITY OFFICE Instructions for Completing Form 01/10 Primes and subcontractors are encouraged to use the form for self assessment and redirection of their recruitment program prior to official or ad hoc department reviews where the report will also be collected Prime contractors are encouraged to incorporate this form in their Certification of Compliance process to facilitate the review of subcontractor compliance with recruitment requirements SECTION 1: Identification of Contractor Box 1• Company's official name Box 2 Company's Federal Identification Number or FDOT vendor number. Box 3 Mark the calendar months that are included in this report and the year(s) Box 4 First and last name of person supplying information on this report Box 5 Job Title of person named in Box 4 Box 6 Phone number including area code of person name in Box 4 Box 7 Email address of person named in Box 4 Box 8 First and last name of Company EEO Officer Box 9* EEO Officer's Signature and date indicating review of reported data Box 10, Mark yes or no to indicate if a letter from the EEO Officer is attached containing additional information A letter from the EEO Officer is not required Box 11 List the street, city, zip code of Florida location where employment applications are accepted and hiring occurs for construction craft and laborer positions Mark N-A (not applicable) if there are no other locations SECTION 2: Compliance with FHWA 1273 Recruitment Requirements Box 12 Complete one set of questions for each location listed in Box 11 Box 13 Indicate if records are available to support each 'Yes' answer in Box 12 SECTION 3: Hiring Summary Report all hires and rehires occurring at all locations for the period shown in Box 3 ('Months included in this report') Summarize hires by Job Category, race and sex. Refer to the EEO Construction Contract Compliance Workbook Attachment 3 4 5, 'EEO Job Category of Classifications' to determine the job category of individual job classifications/job titles. 'Hires' includes all construction craft and laborer employees added to the payroll Rehires are included as hires. Include all of those still employed as of the date of this report plus those who have terminated subsequent to hire. Exclude persons who were offered a job and accepted it but failed to report for work; they are not considered a hire. Total minorities is the sum of Black, Hispanic, American India/Alaskan Native, Asian, Native Hawaiian/other Pacific Islander and Two or More Races. Total Hires is the sum of"Total Minorities' and White SECTION 4: Hires by Location General: At the top of this page, record the Contract actor's Name in Box 1 and their FEID number in Box 2. Record the page number in Box 3 beginning with '2' and continuing sequentially (3, 4, 5, etc) Group the hiring information of each location together: list Location 1 hires together, then list hires of Location 2, etc. A section is provided to record data on each hire and the company's recruitment activity to attract candidates for the position filled Record the details of each hire included in Section 3 Hiring Summary Additional information regarding hiring can be included an optional EEO Officers' letter as referred to in Box 10). A. Hiring Location Mark x next to 1, 2, 3, or 4 corresponding to the hiring locations listed in Box 11 B Job Title Filled New hires'job classification/job title C Hire's Name First name, last name D. Sex and Race Mark x for sex, and x for race ( W for white, H for Hispanic, BI for Black, Al for American Indian or Alaska Native, As for Asian, PI for Native Hawaiian or other Pacific Islander, 2M for Two or more Races E. Hire date Month/Day/Year hired F. Hourly Pay rate: $ xx.xx G. 4-digit Identifier four digit as used on payrolls H How did the hire learn of the job? Report how the hire reported learning of the job I How was this Job Opening Communicated? Indicate yes or no for each of the items listed and provide the additional data indicated (eg. Name of Center, Name of newspaper, etc) J Indicate if records are available to support each 'Yes' answer in Box H K. Repeat for each hire, adding as many additional pages as needed Number each page sequentially SAMPLE FORM FOR EEO COMPLIANCE/DATA COLLECTION NOTE: This form is subject to change or modification