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U. S. CE MAP, rA -•Cf �K(.�LCT Nam'..,A <br />"OuS� NG ANO UOAui DE VE L O PME N T <br />CONTRACTOR •;a Su6CONTRACTU4t IEMFl:li2, <br />RECIIRD OF <br />EMPLOYEE INTERVIEW <br />(Labor Standards) <br />1. <br />NAME OF F'.MPLOVI'E f <br />2. <br />110VIE. ADDRESS AND ZIP CODE <br />3- <br />LAST DATE YOU WORKED ON NUMBER HOURS WORKED CN I <br />PROJECT BEFORE TODAY? PROJECT ON THAT DATE' l <br />6- <br />YOUR IIOURLY PAY RATE' I <br />5. <br />YOUR JOR CLASSIFICATION(S)? •=5 + w0 <br />APprenttte' j <br />6. <br />Y•O1'11 DUTIESI <br />I <br />T. <br />TOOLS OR EQUIPMENT USED' i <br />S. <br />PAID AT LEAST TIME ONE. -HALF FOR ALL HOURS TES w0 I <br />WORKED IN EXCESS OF a IN A DAY OR 40 IN A WFEK? I j <br />9. <br />EYEH THREATENED, INTIMIDATED, OR COERCED INTO <br />GIVING UP ANY PART OF PAYT <br />10. <br />DUTIES ORSFIIVED RY INTERVIEWER <br />YES M: <br />Conform to class ftaatione I <br />11. <br />REMARKS (Continue on reverse i/ necessary) <br />. j <br />i <br />1 <br />i <br />12. <br />SIGNATURE OF INTER1•IFWER <br />DATE OF I,YERN' Es 1 <br />1 <br />PAYROLL EXAMINATION j-:L E. <br />13. <br />CLASSIFICATION CONFORMS TO WAGE DETERMINATION 1 <br />14 <br />I HATF CONFORMS TO WAGE DF.TFRMINATION + <br />15. <br />HOURLY HATF. CONFORMS TO PAYROLL 1 <br />16. <br />HOURS WORKED (ITEM 3) CONFORMS TO PAYROLL ( i <br />17. <br />REIoARKS (Continue on reverse it ntctssary) <br />18. <br />_ I <br />SIGNATURE OF P'.YHtj,.l FXA;4!N"ER DATE. <br />hJO-I I t11.651 HUD -hash., D. C. is-[ar-r ,way. J-61F, <br />O U.S.G:VL�7A11LKi P4IhT;S� :Fr!��a:i :5;-::? <br />