Official Use Only
STATE OF NEW JERSEY
Assignment
DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT
CONSTRUCTION EEO COMPLIANCE MONITORING PROGRAM
Code
FORM AA-201
Revised 11/11
INITIAL PROJECT WORKFORCE REPORT CONSTRUCTION
For instructions on completing the form, go to: http://www.state.nj.us/treasury/contract_compliance/pdf/aa201ins.pdf
1. FID NUMBER
2. CONTRACTOR ID NUMBER 5. NAME AND ADDRESS OF PUBLIC AGENCY AWARDING CONTRACT
3. NAME AND ADDRESS OF PRIME CONTRACTOR
(Name)
CONTRACT NUMBER DATE OF AWARD DOLLAR AMOUNT OF AWARD
(Street Address)
6. NAME AND ADDRESS OF PROJECT
7. PROJECT NUMBER
(City) (State) (Zip Code)
COUNTY
8. IS THIS PROJECT COVERED BY A PROJEC
4. IS THIS COMPANY MINORITY OWNED [ ] OR WOMAN OWNED [ ]
LABOR AGREEMENT (PLA)? YES N
O
9. TRADE OR CRAFT
PROJECTED TOTAL EMPLOYEES PROJECTED MINORITY EMPLOYEES PROJECTED PROJECTED
MALE FEMALE MALE FEMALE PHASE - IN COMPLETION
DATE DATE
1. ASBESTOS WORKER
2. BRICKLAYER OR MASON
3. CARPENTER
4. ELECTRICIAN
5. GLAZIER
6. HVAC MECHANIC
7. IRONWORKER
8. OPERATING ENGINEER
9. PAINTER
10. PLUMBER
11. ROOFER
12. SHEET METAL WORKER
13. SPRINKLER FITTER
14. STEAMFITTER
15. SURVEYOR
16. TILER
17. TRUCK DRIVER
18. LABORER
19. OTHER
20. OTHER
I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements are
willfully
false, I am subject to punishment.
(Signature)
10. (Please Print Your Name) (Title)
(Area Code) (Telephone Number) (Ext.) (Date)
J AP J AP J
AP J
AP
Name:
Address:
Address:
Name:
