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On the Job Training Pre Award Survey <br />1 �- - Sl�f �� l <br />BUSINESS NAME: �� S�G_� IJ�SA. L � STATE TAX LD. # /DO <br />ADDRESS: � . f _ p v <br />FEDERAL TAX I.D. # J � - ���'`%�Y� <br />1 . The business does provide worker's compensation coverage. <br />Policy Number: <br />2. The business does provide General Liability Insurance in the aniount 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 />1 O. Business license is current. <br />1 I . 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 />ros ective OJT em to ee <br />YES NO <br />❑/ ❑ <br />f�' ❑ <br />CLY I_1 <br />�❑ <br />>�� ❑ <br />tl�l j <br />-[�' ❑ <br />ll� � <br />[� ❑ I� /I� <br />.�� � <br />P P P Y �� ❑ <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 operations_ <br />TOTAL WORKFORCE # 3 <br />Comments: <br />Employer Title Date <br />CONTRACT RECOMMENDED YES � NO ❑ <br />Manager <br />Program Supervisor /Director <br />Cy <br />�— <br />