ATTACHMENT_J-1_(Fringe_Benefits).docx

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Cascades Job Corps College and Career Academy
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DOL-ETA-16-R-00010
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ATTACHMENT J-1 (Fringe Benefits)

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ATTACHMENT J-1

FRINGE BENEFITS – ACADEMY OPERATIONS
%
1st Year Pay Base

(a) 2nd Year Pay Base (b) Fringe 1st Year (%*a) Fringe 2nd Year (%*b)

1
Unemployment Insurance
$
$
$
$
2
FICA
$
$
$
$
3
Worker’s Compensation
$
$
$
$
4
Health Insurance
$
$
$
$
5
Dental Insurance
$
$
$
$
6
Life Insurance
$
$
$
$
7
Retirement/Pension
$
$
$
$
8
Other (Specify)
$
$
$
$
9
Total Costs of Fringe Benefits
$
$
$
$

ADDITIONAL INFORMATION

10
Estimated Overtime/Holiday Premium Pay
$
$
11
Estimated Night Differential
$
$
12
Number of Staff Paid Holidays
13
Estimated Total Number Staff Vacation Days
FRINGE BENEFITS – ACADEMY OPERATIONS
%

OY1 Pay Base

Fringe

OY 1

%
OY2 Pay Base

Fringe

OY 2

%
OY3 Pay Base

Fringe

OY 3

1
Unemployment Insurance
$
$
$
$
$
$
2
FICA
$
$
$
$
$
$
3
Worker’s Compensation
$
$
$
$
$
$
4
Health Insurance
$
$
$
$
$
$
5
Dental Insurance
$
$
$
$
$
$
6
Life Insurance
$
$
$
$
$
$
7
Retirement/Pension
$
$
$
$
$
$
8
Other (Specify)
$
$
$
$
$
$
9
Total Costs of Fringe Benefits

ADDITIONAL INFORMATION

10
Estimated Overtime/Holiday Premium Pay
11
Estimated Night Differential
12
Number of Staff Paid Holidays
13
Estimated Total Number Staff Vacation Days
FRINGE BENEFITS – ENROLLMENT SERVICES
%
1st Year Pay Base

(a) 2nd Year Pay Base (b) Fringe 1st Year (%*a) Fringe 2nd Year (%*b)

1
Unemployment Insurance
$
$
$
$
2
FICA
$
$
$
$
3
Worker’s Compensation
$
$
$
$
4
Health Insurance
$
$
$
$
5
Dental Insurance
$
$
$
$
6
Life Insurance
$
$
$
$
7
Retirement/Pension
$
$
$
$
8
Other (Specify)
$
$
$
$
9
Total Costs of Fringe Benefits
$
$
$
$

ADDITIONAL INFORMATION

10
Estimated Overtime/Holiday Premium Pay
$
$
11
Estimated Night Differential
$
$
12
Number of Staff Paid Holidays
13
Estimated Total Number Staff Vacation Days
FRINGE BENEFITS – ENROLLMENT SERVICES
%

OY1 Pay Base

Fringe

OY 1

%
OY2 Pay Base

Fringe

OY 2

%
OY3 Pay Base

Fringe

OY 3

1
Unemployment Insurance
$
$
$
$
$
$
2
FICA
$
$
$
$
$
$
3
Worker’s Compensation
$
$
$
$
$
$
4
Health Insurance
$
$
$
$
$
$
5
Dental Insurance
$
$
$
$
$
$
6
Life Insurance
$
$
$
$
$
$
7
Retirement/Pension
$
$
$
$
$
$
8
Other (Specify)
$
$
$
$
$
$
9
Total Costs of Fringe Benefits

ADDITIONAL INFORMATION

10
Estimated Overtime/Holiday Premium Pay
11
Estimated Night Differential
12
Number of Staff Paid Holidays
13
Estimated Total Number Staff Vacation Days
FRINGE BENEFITS – PLACEMENT SERVICES
%
1st Year Pay Base

(a) 2nd Year Pay Base (b) Fringe 1st Year (%*a) Fringe 2nd Year (%*b)

1
Unemployment Insurance
$
$
$
$
2
FICA
$
$
$
$
3
Worker’s Compensation
$
$
$
$
4
Health Insurance
$
$
$
$
5
Dental Insurance
$
$
$
$
6
Life Insurance
$
$
$
$
7
Retirement/Pension
$
$
$
$
8
Other (Specify)
$
$
$
$
9
Total Costs of Fringe Benefits
$
$
$
$

ADDITIONAL INFORMATION

10
Estimated Overtime/Holiday Premium Pay
$
$
11
Estimated Night Differential
$
$
12
Number of Staff Paid Holidays
13
Estimated Total Number Staff Vacation Days
FRINGE BENEFITS – PLACEMENT SERVICES
%

OY1 Pay Base

Fringe

OY 1

%
OY2 Pay Base

Fringe

OY 2

%
OY3 Pay Base

Fringe

OY 3

1
Unemployment Insurance
$
$
$
$
$
$
2
FICA
$
$
$
$
$
$
3
Worker’s Compensation
$
$
$
$
$
$
4
Health Insurance
$
$
$
$
$
$
5
Dental Insurance
$
$
$
$
$
$
6
Life Insurance
$
$
$
$
$
$
7
Retirement/Pension
$
$
$
$
$
$
8
Other (Specify)
$
$
$
$
$
$
9
Total Costs of Fringe Benefits

ADDITIONAL INFORMATION

10
Estimated Overtime/Holiday Premium Pay
11
Estimated Night Differential
12
Number of Staff Paid Holidays
13
Estimated Total Number Staff Vacation Days

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