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Form preview Employment agreement form For Office Use Only Profile No Contract Compliance Form Reporting Compliance with D.C. Law 14-24 Mayor s Order 83-265 and D.C. Law 5-93 First Source Employment Agreement Instructions To be completed by the employer and submitted on the 10th of each month until completion of the project. Forward to Department of Employment Services DOES 609 H Street N*E* Room 431 Washington D*C* 20002 Telephone 202 698-5772 Fax 202 698-5717 Website www. does. dc*gov Reporting Period 20 Name of Firm Address Contact Person E-mail Title Telephone Number Employer Federal Identification Number Contract/Loan Number Project Location Project Start Date Project End Date Contracting/Lending Agency I. Vacancies Referrals and Hires Please provide monthly and cumulative statistics for the number of jobs created referrals made and hires. Cumulative This Month Number of Vacancies Currently Available Total Number of Hires Number of District Residents Hired Number of DOES Referrals Hired Number of Current Employees Transferred to Work on Project Referrals Made by Other Sources DOES Referrals Made II. New Hires This Month List the name social security number job title hire date and place of residence for all new hires. Referral sources are 1 DOES and 2 Other Referral Sources specify. NAME SSN ADDRESS WARD DC Only JOB TITLE HIRE DATE REFERRAL SOURCE III. Current Workforce This Month to work on the project this month. HIRE DATE IV. Laid-Off Employees This Month V. Terminations This Month TERMINATION PLACE OF RESIDENCE VI. Indicate whether your firm is 1. A Certified Local Small Disadvantaged Business YES NO If yes certification number 2. A non-certified Local Small Disadvantaged Business YES NO Do you have a registered Apprenticeship program with the D*C* Apprenticeship Council YES If yes D*C* Apprenticeship Council Registration Number VIII. Subcontractor If yes specify Prime Contractor IX. Comments Describe any problems you have experienced in meeting your job creation projections in implementing the Signature Date. Forward to Department of Employment Services DOES 609 H Street N*E* Room 431 Washington D*C* 20002 Telephone 202 698-5772 Fax 202 698-5717 Website www. does. dc*gov Reporting Period 20 Name of Firm Address Contact Person E-mail Title Telephone Number Employer Federal Identification Number Contract/Loan Number Project Location Project Start Date Project End Date Contracting/Lending Agency I. does. dc*gov Reporting Period 20 Name of Firm Address Contact Person E-mail Title Telephone Number Employer Federal Identification Number Contract/Loan Number Project Location Project Start Date Project End Date Contracting/Lending Agency I. Vacancies Referrals and Hires Please provide monthly and cumulative statistics for the number of jobs created referrals made and hires. Vacancies Referrals and Hires Please provide monthly and cumulative statistics for the number of jobs created referrals made and hires. Cumulative This Month Number of Vacancies Currently Available Total Number of Hires Number of District Residents Hired Number of DOES Referrals Hired Number of Current Employees Transferred to Work on Project Referrals Made by Other Sources DOES Referrals Made II.

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