2-EEO Affirmative Action Compliance Documentation Form AA302.pdf
PDF 217 KB Posted
- Solicitation number
- RFQ 2140
- Issued by
- Atlantic County, New Jersey
About this file
This is an EEO Affirmative Action Compliance Documentation Form AA302, issued by the State of New Jersey Division of Purchase & Property Contract Compliance Audit Unit, required for companies awarded state contracts. The form serves as an employee information report for Equal Employment Opportunity monitoring purposes and must be completed by contractors awarded state contracts, including those bidding on the Atlantic Cape Community College RFQ 2140 for hood cleaning services across the Mays Landing, Atlantic City, and Cape May County campuses. Contractors are required to report all permanent, temporary, and part-time employees on their own payroll, broken down by job category and demographic information including gender and race/ethnicity. The form requires detailed employment data across nine job categories: Officials/Managers, Professionals, Technicians, Sales Workers, Office & Clerical, Craftworkers, Operatives, Laborers, and Service Workers, with separate columns for male and female employees further categorized by race and ethnic background.
Submission of the completed Form AA302 requires a $150.00 fee, and failure to properly complete the form and submit the required fee may delay issuance of the contractor's certificate. The form must be accompanied by documentation of the payroll period used for the employment data reported, and contractors must indicate whether the information regarding race or ethnic group was obtained through visual survey, employment records, or other means. The form requests company identification information including Federal ID Number or Social Security Number, business type, total employee count, establishment status, and identification of the public agency awarding the contract. Contractors must sign the form and provide contact information for the person completing the documentation. Instructions for completing the form are available on the New Jersey Treasury website.
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Text version
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:
https://www.state.nj.us/treasury/contract_compliance/documents/pdf/forms/aa302ins.pdf
SECTION A - COMPANY IDENTIFICATION
1. FID. NO. OR SOCIAL SECURITY 2. TYPE OF BUSINESS 3. TOTAL NO. EMPLOYEES IN THE ENTIRE
1. MFG 2. SERVICE 3. WHOLESALE COMPANY
4. RETAIL 5. OTHER
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
7. CHECK ONE: IS THE COMPANY: SINGLE-ESTABLISHMENT EMPLOYER MULTI-ESTABLISHMENT EMPLOYER
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 CONTRACT
CITY COUNTY STATE ZIP CODE
Official Use Only DATE RECEIVED INAUG.DATE ASSIGNED CERTIFICATION NUMBER
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.
ALL EMPLOYEES PERMANENT MINORITY/NON-MINORITY EMPLOYEE BREAKDOWN
JOB COL. 1 COL. 2 COL. 3 ********* MALE************************************FEMALE**********************
CATEGORIES TOTAL MALE FEMALE AMER. NON AMER. NON
(Cols.2 &3) BLACK HISPANIC INDIAN ASIAN MIN. BLACK HISPANIC INDIAN ASIAN 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? 14. IS THIS THE FIRST 15. IF NO, DATE LAST
1. Visual Survey 2. Employment Record 3. Other (Specify) Employee Information REPORT SUBMITTED
Report Submitted?
13. DATES OF PAYROLL PERIOD USED
From: To: 1. YES 2. NO
MO. DAY YEAR
SECTION C - SIGNATURE AND IDENTIFICATION
16. NAME OF PERSON COMPLETING FORM (Print or Type) SIGNATURE TITLE DATE
MO DAY YEAR
17. ADDRESS NO. & STREET CITY COUNTY STATE ZIP CODE PHONE (AREA CODE, NO.,EXTENSION)
The data below shall NOT be included in the figures for the appropriate categories above.
https://www.state.nj.us/treasury/contract_compliance/documents/pdf/forms/aa302ins.pdf
Form AA- 302 Treasury D:20000727094525- 04'00' D:20000727094709- 04'00' 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: https://www.state.nj.us/treasury/contract_compliance/documents/pdf/forms/aa302ins.pdf
SECTION A - COMPANY IDENTIFICATION
1. FID. NO. OR SOCIAL SECURITY
2. TYPE OF BUSINESS
3. TOTAL NO. EMPLOYEES IN THE ENTIRE
1. MFG
2. SERVICE
3. WHOLESALE
COMPANY
4. RETAIL 5. OTHER
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
7. CHECK ONE: IS THE COMPANY:
SINGLE-ESTABLISHMENT EMPLOYER
MULTI-ESTABLISHMENT EMPLOYER
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 CONTRACT
CITY
COUNTY
STATE
ZIP CODE
Official Use Only
DATE RECEIVED
INAUG.DATE
ASSIGNED CERTIFICATION NUMBER
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 areno 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.
ALL EMPLOYEES
PERMANENT MINORITY/NON-MINORITY EMPLOYEE BREAKDOWN
JOB COL. 1
COL. 2 COL. 3 ********* MALE************************************FEMALE**********************
CATEGORIES TOTAL MALE FEMALE
AMER.
NON
AMER. NON
(Cols.2 &3)
BLACK HISPANIC INDIAN ASIAN MIN. BLACK HISPANIC INDIAN ASIAN 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? 14. IS THIS THE FIRST
15. IF NO, DATE LAST
1. Visual Survey 2. Employment Record 3. Other (Specify) Employee Information
REPORT SUBMITTED
Report Submitted?
13. DATES OF PAYROLL PERIOD USED
From:
To:
1. YES
2. NO
MO. DAY YEAR
SECTION C - SIGNATURE AND IDENTIFICATION
16. NAME OF PERSON COMPLETING FORM (Print or Type)
SIGNATURE
TITLE
DATE
MO DAY YEAR
17. ADDRESS NO. & STREET
CITY
COUNTY
STATE
ZIP CODE PHONE (AREA CODE, NO.,EXTENSION)
The data below shall NOT be included in the figures for the appropriate categories above.
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