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EMPLOYMENT PLAN
NAME OF EMPLOYER: ____________________________________________________________
ADDRESS OF EMPLOYER: _________________________________________________________
TELEPHONE NUMBER: ________________ FEDERAL IDENTIFICATION NO.:_____________
CONTACT PERSON: ____________________________ TITLE: ____________________________
E-MAIL:______________________________TYPE OF BUSINESS: _________________________
DISTRICT CONTRACTING AGENCY: _______________________________________________
CONTRACTING OFFICER: ________________________ TELEPHONE NUMBER: ___________
TYPE OF PROJECT: _________________________CONTRACT AMOUNT: _________________
EMPLOYER CONTRACT AMOUNT: ______________________________________________
PROJECT START DATE: ______________________PROJECT END DATE: _________________
EMPLOYER START DATE: ______________________EMPLOYER END DATE: _____________
NEW JOB CREATION PROJECTIONS: Please indicate ALL new position(s) your firm
will create as a result of the Project. If the firm WILL NOT be creating any new
employment opportunities, please complete the attached justification sheet with an
explanation. Attach additional sheets as needed.
JOB TITLE # OF JOBS
F/T P/T
SALARY
RANGE
UNION MEMBERSHIP REQUIRED
NAME LOCAL#
PROJECTED
HIRE DATE
A
B
C
D
E
F
G
H
I
J
K
Revised 3/11 for the Government of the District of Columbia
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CURRENT EMPLOYEES: Please list the names, residency status and ward information of all
current employees, including apprentices, trainees, and transfers from other projects, who will be
employed on the Project. Attach additional sheets as needed.
NAME OF EMPLOYEE CURRENT DISTRICT
RESIDENT
Please Check
WARD
Revised 3/11 for the Government of the District of Columbia
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JUSTIFICATION SHEET: Please provide a detailed explanation of why the Employer will not
have any new hires on the Project.
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Revised 3/11 for the Government of the District of Columbia