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On the Job Training Pre Award Survey <br />BUSINESS NAME: O_ h Insurance Aeency STATE TAX I.D. # 464-94407 <br />ADDRESS: 1421 Warner Ave.. Suite D <br />Tustin. CA 92780 FEDERAL TAX LD. # 33-0937743 <br />(714) 247-1030 <br /> YES NO <br />1. The business does provide worker's compensation coverage. x ? <br /> Policy Number: <br />2. The business does provide General Liability Insurance in the amount of x ? <br /> One Million Dollars ($1,000,000). Policy must identify the City of Santa Ana as <br /> the certificate holder. <br />3. The system used for business accounting does document cash received, state and <br /> federal tax withholdings, FICA deductions. x ? <br />4. The business has not been cited for any health, safety, wage and hour, or child <br /> labor violations during the past 12 months. x ? <br />5. The business maintains a grievance and/or complaint handling procedures for x ? <br /> employees. <br />6. The prospective OJT client is not a former employee of the business. x ? <br />7. Wages for the planned OJT position are wages comparable to similar positions. x ? <br />8. A written job description for this position is on file. x ? <br />9. Union concurrence has been obtained. ? xN/A <br />1 O. Business license is current. x ? <br />1 1. The business has not had any employees laid off in the past 6 months. x ? <br />12. The business is financially stable and has the means to train and pay for the <br /> prospective OJT employee. x ? <br /> <br /> The employer stipulates and agrees by signing below that the establishment in which on-the job <br /> training will be given: <br /> (1) Has not been moved from any previous location less than 120 days prior to the effective date of the <br /> OJT contract. <br /> (2) Is not a branch, affiliate or subsidiary of a business entity in another location which has, at any time <br /> subsequent to the date of the OJT contract, relocated or expanded so as to cause an increase in <br /> unemployment or the closing down of operations in which the entity conducts business operatio ns. <br />TOTAL WORKFORCE # <br />CONTRACT RECOMMENDED YES ? NO ? <br />Comments: <br />??`b ) ? <br />E oyer Title Date <br />J?/? <br />OJT Coordinator/Case Mdnage?-/ Date " <br />Program Supervisor/Director Date