Fillable Renewal Package For The Certificate Of Employee Information Report (NJ Department of Treasury)

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Renewal Package For The Certificate Of Employee Information Report (NJ Department of Treasury)

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PHILIP D. MURPHY
Governor
State of New Jersey
DEPARTMENT OF THE TREASURY
DIVISION OF PURCHASE AND PROPERTY
CONTRACT COMPLIANCE & AUDIT UNIT
EEO MONITORING PROGRAM
33 WEST STATE STREET
P. O. BOX 206
TRENTON, NEW JERSEY 08625-0206
ELIZABETH MAHER MUOIO
State Treasurer
SHEILA Y. OLIVER
Lt. Governor
MAURICE A. GRIFFIN
Acting Director
RENEWAL NOTICE
The Certificate of Employee Information Report (hereinafter referred to as the “State Certificate”)
issued by this Division is due to expire within the next 90 days. In order for your firm to continue to
provide a current State Certificate for public contract awards, you must apply for renewal by properly
completing the following renewal documents:
1. The Employee Information Report Form AA-302 for the facility indicated on the “State
Certificate” and any additional New Jersey facilities, with a check in the amount of $150.00
payable to “the Treasurer, State of New Jersey” (fee is non-refundable) and
2. The Vendor Activity Summary Report forms, one for each of the four (4) personnel activities
noted (new hires, promotions, transfers and terminations etc.) for the previous “State
Certificate” period, or
3. If you are operating under a federally approved affirmative action plan, a photocopy of the
letter of Federal Approval issued by the US Department of Labor, Office of Federal Contract
Compliance Programs, not greater than one year old, may be submitted to the awarding
agency in lieu of the State Certificate. Please do not submit an EEO-1 Report as it will not be
accepted.
All goods, service and professional service vendors are encouraged to complete and file these
renewal documents electronically by accessing the Division’s website at
www.state.nj.us/treasury/contract_compliance. This website provides access to the forms in electronic
format or on-line internet submission registration via the internet. You may also call the Division at (609)
292-5473 and a representative will assist you. Please have your State Certificate number ready when
calling. Your State Certificate number is noted at the end of your company name on your mailing label.
Upon receipt of the above-referenced documents, the Division will approve or reject your application
within sixty (60) days of submission. If your application is approved, the Division will issue a State
Certificate provided your firm meets the standards of good faith compliance with the Affirmative Action
Regulations set forth in N.J.A.C. 17:27-1.1 et seq. Periodic reviews may be conducted and additional
information may be requested, as required by the Division. In all instances, however, a copy of the State
Certificate must be presented to the public agency awarding the contract, prior to the award of the
contract.
Rev. 4-18
Form AA302
Rev. 11/11
STATE OF NEW JERSEY
Division of Purchase & Property
Contract Compliance Audit Unit
EEO Monitoring Program
EMPLOYEE INFORMATION REPORT
IMPORTANT-READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM. FAILURE TO PROPERLY COMPLETE THE ENTIRE FORM AND TO SUBMIT THE REQUIRED
$150.00 FEE MAY DELAY ISSUANCE OF YOUR CERTIFICATE. DO NOT SUBMIT EEO-1 REPORT FOR SECTION B, ITEM 11. For Instructions on completing the form, go to:
http://www.state.nj.us/treasury/contract_compliance/pdf/aa302ins.pdf
SECTION A - COMPANY IDENTIFICATION
1. FID. NO. OR SOCIAL SECURITY
2. TYPE OF BUSINESS
1. MFG 2. SERVICE 3. WHOLESALE
4. RETAIL 5. OTHER
3. TOTAL NO. EMPLOYEES IN THE ENTIRE
COMPANY
4. COMPANY NAME
5. STREET CITY COUNTY STATE ZIP CODE
6. NAME OF PARENT OR AFFILIATED COMPANY (IF NONE, SO INDICATE) CITY STATE ZIP CODE
8. IF MULTI-ESTABLISHMENT EMPLOYER, STATE THE NUMBER OF ESTABLISHMENTS IN NJ
9. TOTAL NUMBER OF EMPLOYEES AT ESTABLISHMENT WHICH HAS BEEN AWARDED THE CONTRACT
10. PUBLIC AGENCY AWARDING CONTRAC
CITY COUNTY STATE ZIP CODE
Official Use Only
DATE RECEIVED
INAUG.DATE
SECTION B - EMPLOYMENT DATA
11. Report all permanent, temporary and part-time employees ON YOUR OWN PAYROLL. Enter the appropriate figures on all lines and in all columns. Where there are
no employees in a particular category, enter a zero. Include ALL employees, not just those in minority/non-minority categories, in columns 1, 2, & 3. DO NOT SUBMIT
AN EEO-1 REPORT.
SECTION C - SIGNATURE AND IDENTIFICATION
17. ADDRESS NO. & STREET CITY COUNTY STATE ZIP CODE PHONE (AREA CODE, NO.,EXTENSION)
- -
16. NAME OF PERSON COMPLETING FORM (Print or Type)
SIGNATURE
TITLE
DATE
MO DAY YEAR
7. CHECK ONE: IS THE COMPANY:
SINGLE-ESTABLISHMENT EMPLOYER
MULTI-ESTABLISHMENT EMPLOYER
ALL EMPLOYEES
JOB
CATEGORIES
PERMANENT MINORITY/NON-MINORITY EMPLOYEE BREAKDOWN
*********
*****
NON
MIN.
Officials/ Managers
Professionals
Technicians
Sales Workers
Office & Clerical
Craftworkers
(Skilled)
Operatives
(Semi
-skilled)
Laborers
(Unskilled)
Service Workers
TOTAL
Total employment
From previous
Report (if any)
Temporary & Part
-
Time Employees
12. HOW WAS INFORMATION AS TO RACE OR ETHNIC GROUP IN SECTION B OBTAINED?
1. Visual Survey 2. Employment Record 3. Other (Specify)
14. IS THIS THE FIRST
Employee Information
Report Submitted?
15. IF NO, DATE LAST
REPORT SUBMITTED
MO.DAY YEAR
13. DATES OF PAYROLL PERIOD USED
From:
To:
1. YES
2. NO
The data below shall
NOT
be included in the figures for the appropriate categories above.
ASIAN
AMER.
INDIAN
HISPANIC
BLACK
NON
MIN.
ASIAN
AMER.
INDIAN
HISPANIC
BLACK
*********
E********
*****FEMAL
******** MALE**********************
*
COL. 3
FEMALE
COL. 2
MALE
COL. 1
TOTAL
(Cols.2 &3)
INSTRUCTIONS FOR COMPLETING THE
EMPLOYEE INFORMATION REPORT (FORM AA302)
IMPORTANT: READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE FORM.
PRINT OR TYPE ALL INFORMATION. FAILURE TO PROPERLY COMPLETE THE ENTIRE FORM AND TO
SUBMIT THE REQUIRED $150.00 NON-REFUNDABLE FEE MAY DELAY ISSUANCE OF YOUR CERTIFICATE. IF
YOU HAVE A CURRENT CERTIFICATE OF EMPLOYEE INFORMATION REPORT, DO NOT COMPLETE THIS
FORM UNLESS YOUR ARE RENEWING A CERTIFICATE THAT IS DUE FOR EXPIRATION. DO NOT COMPLETE
THIS FORM FOR CONSTRUCTION CONTRACT AWARDS.
ITEM 1 - Enter the Federal Identification Number assigned by
the Internal Revenue Service, or if a Federal Employer
Identification Number has been applied for, or if your
business is such that you have not or will not receive a
Federal Employer Identification Number, enter the Social
Security Number of the owner or of one partner, in the case
of a partnership.
ITEM 2 - Check the box appropriate to your TYPE OF
BUSINESS. If you are engaged in more than one type of
business check the predominate one. If you are a
manufacturer deriving more than 50% of your receipts from
your own retail outlets, check “Retail”.
ITEM 3 - Enter the total “number” of employees in the entire
company, including part-time employees. This number shall
include all facilities in the entire firm or corporation.
ITEM 4 - Enter the name by which the company is identified.
If there is more than one company name, enter the
predominate one.
ITEM 5 - Enter the physical location of the company. Include
City, County, State and Zip Code.
ITEM 6 - Enter the name of any parent or affiliated company
including the City, County, State and Zip Code. If there is
none, so indicate by entering “None” or N/A.
ITEM 7 - Check the box appropriate to your type of company
establishment. “Single-establishment Employer” shall include
an employer whose business is conducted at only one
physical location. “Multi-establishment Employer” shall
include an employer whose business is conducted at more
than one location.
ITEM 8 - If “Multi-establishment” was entered in item 8, enter
the number of establishments within the State of New Jersey.
ITEM 9 - Enter the total number of employees at the
establishment being awarded the contract.
ITEM 10 - Enter the name of the Public Agency awarding the
contract. Include City, County, State and Zip Code. This is
not applicable if you are renewing a current Certificate.
ITEM 11 - Enter the appropriate figures on all lines and in all
columns. THIS SHALL ONLY INCLUDE EMPLOYMENT
DATA FROM THE FACILITY THAT IS BEING AWARDED
THE CONTRACT. DO NOT list the same employee in more
than one job category. DO NOT attach an EEO-1 Report.
Racial/Ethnic Groups will be defined:
Black: Not of Hispanic origin. Persons having origin in any of
the Black racial groups of Africa.
Hispanic: Persons of Mexican, Puerto Rican, Cuban, or
Central or South American or other Spanish culture or origin,
regardless of race.
American Indian or Alaskan Native: Persons having origins
in any of the original peoples of North America, and who
maintain cultural identification through tribal affiliation or
community recognition.
Asian or Pacific Islander: Persons having origin in any of
the original peoples of the Far East, Southeast Asia, the
Indian Sub-continent or the Pacific Islands. This area
includes for example, China, Japan, Korea, the Phillippine
Islands and Samoa.
Non-Minority:
Any Persons not identified in any of the
aforementioned Racial/Ethnic Groups.
ITEM 12 - Check the appropriate box. If the race or ethnic
group information was not obtained by 1 or 2, specify by what
other means this was done in 3.
ITEM 13 - Enter the dates of the payroll period used to
prepare the employment data presented in Item 12.
ITEM 14 - If this is the first time an Employee Information
Report has been submitted for this company, check block
“Yes”.
ITEM 15 - If the answer to Item 14 is “No”, enter the date
when the last Employee Information Report was submitted by
this company.
ITEM 16 - Print or type the name of the person completing
the form. Include the signature, title and date.
ITEM 17 - Enter the physical location where the form is being
completed. Include City, State, Zip Code and Phone Number.
TYPE OR PRINT IN SHARP BALL POINT PEN
THE VENDOR IS TO COMPLETE THE EMPLOYEE INFORMATION REPORT FORM (AA302) AND RETAIN A COPY FOR THE
VENDOR’S OWN FILES. THE VENDOR SHOULD ALSO SUBMIT A COPY TO THE PUBLIC AGENCY AWARDING THE CONTRACT
IF THIS IS YOUR FIRST REPORT; AND FORWARD ONE COPY WITH A CHECK IN THE AMOUNT OF $150.00 PAYABLE TO
THE TREASURER, STATE OF NEW JERSEY(FEE IS NON-REFUNDABLE) TO:
NJ Department of the Treasury
Division of Purchase & Property
Contract Compliance Audit Unit
EEO Monitoring Program
P.O. Box 206
Trenton, New Jersey 08625-0206 Telephone No. (609) 292-5473
__
__
__
__
***********************************************************************************************************************************
STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY
Division of Purchase & Property Contract Compliance Audit Unit EEO Monitoring Program
VENDOR ACTIVITY SUMMARY REPORT
_ NEW HIRES _ PROMOTIONS _ TRANSFERS _TERMINATIONS (CHECK (X) APPROPRIATE ACTIVITY)
CERTIFICATE NO. DATES OF PAYROLL PERIOD USED: FROM TO
===================================================================================================================================
NAME OF FACILITY:
County State Zip CodeStreet City
===================================================================================================================================
JOB MALE FEMALE
CATAGORIES
Total Black Hispanic
AM.Indian Asian Non-Min.
Total Black
Hispanic
AM.Indian
Asian Non-Min.
===================================================================================================================================
OFFICIALS & MANAGERS
PROFESSIONALS
TECHNICIANS
SALES WORKERS
OFFICE & CLERICAL
CRAFTWORKERS
OPERATIVES
LABORERS
SERVICE WORKERS
TOTAL
===================================================================================================================================
I certify that the information on this Form is true and correct.
NAME OF PERSON COMPLETING FORM (Print or Type) SIGNATURE DATE SUBMITTED
LAST FIRST MI
ADDRESS(NO. & STREET) (CITY) (STATE) (ZIP) PHONE(AREA CODE,NO.,EXTENSION)
***********************************************************************************************************************************
INSTRUCTIONS
VENDOR ACTIVITY SUMMARY REPORTS
1. You should complete 4 blank Vendor Activity Summary
Reports with your AA-302, Employee Information Report
Renewal Application package. These 4 Reports are to be
completed for new hires, promotions, transfers and
terminations that took place between the time you
received your Certificate of Employee Information
Report (hereafter referred to as "Certificate") and the
date of your Renewal Application.
2. The Vendor Activity Summary Reports must be completed
to show your firm's total personnel actions for the
previous Certificate period. For example, if your firm
renews its Certificate every 3 years, one of the
reports should indicate the total number of people
hired during the entire 3-year period during which you
held the Certificate. Another report should indicate
the total number of people terminated during that 3-
year period. The third report should indicate the total
number of people transferred during that 3-year period
and the final report should indicate the total number
of people promoted during that 3-year period. Please
note, there is no need to re-state the information
provided on the AA-302 form.
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Renewal Package For The Certificate Of Employee Information Report (NJ Department of Treasury)

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Completed 13 August 2020

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