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On the /Job T^ _r?aining Pre Award Survey <br />BUSINESS NAME:?J?'?,?? 1?0??Yl/{?XU1-YN STATE TAX I.D. # vZ?Z? ? 3?? - <br />ADDRESS: iz,6iti S - ?uoh s - ?! - Q?ISO/3 <br />?y???? FEDERAL TAX I.D. # GI <br />YES NO <br />1. 's compensation coverage. <br />The business does provide worke <br />r p? ? <br /> / <br />? <br />Policy Number: / ? ?i?i.Sf?g'?Q? / <br />2. The business does provide General Liability Insurance in the amount of 0/ ? <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. B? ? <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. Q/ ? <br />9. Union concurrence has been obtained. ? ?.1`/?- ? <br />10. 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 /> 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 effec tive 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 i ncrease in <br /> unemployment or the closing down of operations in which the entity conducts business operations. <br />TOTAL WORKFORCE # ?? <br />CONTRACT RECOMMENDED YES ? NO ? <br />Comments: <br /> ?M?r X1 3 ? ??a_ <br />Emp?oyer ` Title Date OJT <br />Program Supervisor/Director <br />3t <br />?_ l?? t <br />Date