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On the Job Training Pre Award Surve/y <br />BUSINESS NAME: Pi lT? ? I U.SA L[.-G STATE TAX LD. # /?(7 - 8I `f (,s <br />ADDRESS: _ , . -} _ p <br />A FEDERAL TAX I.D. # / ? -????9?Z <br />0. G <br />1. The business does provide worker's compensation coverage. <br />Policy Number: <br />2. The business does provide General Liability Insurance in the amount of <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. <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. <br />5. The business maintains a grievance and/or complaint handling procedures for <br />employees. <br />6. The prospective OJT client is not a former employee of the business. <br />7. Wages for the planned OJT position are wages comparable to similar positions. <br />8. A written job description for this position is on file. <br />9. Union concurrence has been obtained. <br />t O. Business license is current. <br />1 1. The business has not had any employees laid off in the past 6 months. <br />12. The business is financially stable and has the means to train and pay for the <br />prospective OJT employee. <br />YES NO <br />Ci C1 <br />k?' ? <br />[?/f <br />?f f <br />tl?! C <br />Gl'/ L-- I <br />U? LI <br />[ I / I I I??p1- <br />1,?' = C.I <br />'}?!? ? C <br />I1 <br />I'he 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 operations. <br />TOTAL WORKFORCE # 3 <br />Comments_ <br />CONTRACT RECOMMENDED YES NO t J <br />Employer Title Date <br />Manager <br /> <br />Program Supervisor/Director