WisDOT NE Region Wage & EEO Interview Form Project Information Label Questions, please call Jason Johnson, (920) 492-5728 NE Region Labor Compliance

Date _____________________________

Name _____________________________________________ Employer/Company ___________________________________

Supervisor/foreman __________________________________ How long have you been on this project? ___________________

Work Classification _______________________________________ If an Operator, what type __________________________

Type of work you do (job duties/tools/equipment) _____________________________________________________________________

Truck driver? Yes No If Yes, who owns the truck? __________________________________________________________

How much are you paid per hour on this project? __________________________ Are you an apprentice? Yes No

Are you in a union? Yes No If Yes, union name____________________________________ Local # _________________

Health Insurance Pension Vacation Holiday Other: __________________________

If No, what benefits does the company provide?

Are you paid overtime after 10 hours per day? Yes No Are you paid overtime after 40 hours per week? Yes No

Are you paid at least time and a half for work on Saturdays, Sundays, and certain holidays? Yes No

How much are you paid per hour for overtime? ________________ Is overtime paid in the week it is earned? Yes No

Do you know where the job posters including the wage rates are located on this project? Yes No

Have you witnessed any discrimination on this project? Yes No If Yes, explain ___________________________________

_______________________________________________________________________________________________________

Does your employer take any deductions from your pay other than taxes and social security? Yes No

If Yes, explain___________________________________________________________________________________________

Do you make out your own time card? Yes No Are you paid at least once a week? Yes No Paid by: cash check

Have you had any PROBLEMS with your wages? Yes No If Yes, explain ________________________________________

_______________________________________________________________________________________________________

*Keep accurate record of the hours you work, type of work you did, equipment you used, truck#, in case you need to prove you were underpaid

Comments or concerns:

Interviewed by________________________________________________________	Reviewed by_________________

Project Field Staff	NE Labor Compliance

PROJECT STAFF: Do at least 2 field interviews per contractor.

Return original completed form to NE Regional Office, ATTN Labor Compliance.

Questions, please contact Jason Johnson, 920-492-5728, NE Region Labor Compliance Specialist