11-10 Exh V.pdf
PDF 166 KB Posted
- Attached to
- Nine (9) Year Overhaul Slewing Ring
- Solicitation number
- 2086949
- Issued by
- Dallas County, Texas
About this file
This is an Employee Information Report (DART Form 33.254) submitted to the Dallas Area Rapid Transit Authority (DART) in Dallas, Texas, serving as a compliance document for employment data reporting. The form requires employers to provide comprehensive workforce demographic information organized by job category, including officials/managers, professionals, technicians, sales workers, office and clerical staff, craft workers, operatives, laborers, and service workers. The report categorizes employees by gender and ethnicity across five racial/ethnic categories: White (Not of Hispanic Origin), Black (Not of Hispanic Origin), Hispanic, Asian or Pacific Islander, and American Indian or Alaskan Native. Employers must report all permanent full-time and part-time employees, apprentices, and on-the-job trainees, and the form requires identification of whether apprentices are employed at the establishment and the specific payroll period dates used for reporting.
The form serves as a certification document requiring completion and signature by an authorized official who attests that all reported information is accurate and prepared in accordance with the provided instructions. The document distinguishes between single-establishment employers and multi-establishment employers, requiring consolidated reports from larger organizations with multiple locations. Section B requests parent company and establishment identification information along with an employer ID number, while Section C requires description of the establishment's major activity and specific products or services provided. This report appears to be a standard compliance requirement for contractors or vendors conducting business with or employed by DART.
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Text version
B-2086949
DART Form 33.254(04/04) Page 1 of 2
DALLAS AREA RAPID TRANSIT AUTHORITY
DALLAS, TX
EXHIBIT V
EMPLOYEE
INFORMATION REPORT
SECTION A - TYPE OF REPORT
Indicate by marking in the appropriate box the type of reporting unit for which this copy of the form is submitted (MARK ONLY ONE BOX).
Single Establishment Employer Report Multi-Establishment Employer, Consolidated Report (Required) Multi-Establishment Employer, Headquarters Unit Report (Required) Multi-Establishment Employer, Individual Establishment Report (submit one for each establishment with 50 or more employees) Multi-Establishment Employer, Special Report
Total number of reports being filed by this company (answer only if consolidated report).
SECTION B-COMPANY IDENTIFICATION
(To be answered by all)
Parent Company Name & Address:
Establishment Completing Report
Name & Address (Omit if same as above)
Employer ID Number:
SECTION C - ESTABLISHMENT INFORMATION
(Omit on the Consolidated Report)
1. What is the major activity of this establishment? (Be specific, i.e., manufacturing steel castings, retail grocer, wholesale plumbing supplies, title insurance, etc. Include the specific type of product or type of service provided, as well as the principal business or industrial activity.)
B-2086949
DART Form 33.254(04/04) Page 2 of 2
SECTION D-EMPLOYMENT DATA
Employment at this establishment -- Report all permanent full-time and part-time employees including apprentices and on-the-job trainees unless specifically excluded as set forth in the instructions. Enter the appropriate figures on all lines and in all columns.
Blank spaces will be considered zeros.
JOB
CATEGORIES
NUMBER OF EMPLOYEES
Overall Totals
(Sum of Col. B
Thru K)
MALE
FEMALE
White (Not of
Hispanic Origin)
Black (Not of
Hispanic Origin)
Hispanic Asian or Pacific
Islander America n Indian or Alaskan Native
White (Not of
Hispanic Origin)
Black (Not of
Hispanic Origin)
Hispanic Asian or Pacific
Islander America n Indian or Alaskan Native
Officials/Managers Professionals Technicians Sales Workers Office & Clerical Craft Workers (Skilled)
Operatives (Semi-Skilled)
Laborers (Unskilled)
Service Workers
TOTAL
Answer if not consolidated report: Dates of Payroll Period
Used
Does the establishment employ apprentices?
SECTION E - CERTIFICATION
(See Instructions concerning certification in Exhibit G)
Check One: All reports are accurate and were prepared in accordance with the instructions (check on consolidated only)
This report is accurate and was prepared in accordance with the instructions.
Name/Title of Certifying Official
Signature Date:
Contact Name
Address (Number & Street)
Title City & State
Zip Code Telephone Extension
File details come from the government source that posted it. Updated .