Form CEM-2504 "Employee Interview: Labor Compliance / Eeo" - California

What Is Form CEM-2504?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2020;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-2504 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-2504 "Employee Interview: Labor Compliance / Eeo" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONFIDENTIAL
EMPLOYEE INTERVIEW: LABOR COMPLIANCE / EEO
This document contains personal information and subject to
Civil Code 1798.24, it shall be kept confidential in order to
CEM-2504 (REV 05/2020) CT #7541-3512-3
protect against unauthorized disclosure.
FED NO.
CONTRACT NO.
INSTRUCTIONS - (SEE REVERSE SIDE)
1.
QUESTIONS TO BE ASKED OF EMPLOYEE
EMPLOYEE NAME
LABOR CLASSIFICATION
EMPLOYEE ADDRESS
PHONE
DIR BASE WAGE (Filled in by Labor Compliance)
BASE RATE
FRINGE BENEFITS (Filled in by Labor Compliance)
PRIME CONTRACTOR
EMPLOYER
WORK BEING PERFORMED AT TIME OF INTERVIEW
IF OPERATOR, WHAT TYPE OF EQUIPMENT?
A. HOW LONG HAVE YOU WORKED FOR YOUR PRESENT EMPLOYER? HOW LONG ON THIS PROJECT?
B. DESCRIBE THE TYPE OF WORK YOU HAVE BEEN DOING THIS PAST WEEK
C. WHAT IS YOUR WAGE [Include Base and Fringe Benefits (Compare to Payroll)]
DO YOU KEEP A RECORD OF THE HOURS YOU WORK?
YES
NO
D. DO YOU WORK OVERTIME?
IF NO, EXPLAIN
ARE YOU PAID TIME AND
FREQUENTLY
SELDOM
NONE
ONE-HALF FOR OVERTIME?
YES
NO
2.
TRAVEL
DRIVE OR RIDE IN COMPANY VEHICLE TO WORK SITES?
HOW MANY MILES DO YOU TRAVEL TO WORK?
DRIVE
RIDE
NEITHER
ARE YOU REQUIRED TO REPORT TO THE YARD FIRST?
DO YOU DRIVE A PERSONAL VEHICLE TO WORKSITES?
YES
NO
YES
NO
3.
EEO
YES
NO
A. HAVE YOU SEEN THE REQUIRED WAGE RATE POSTERS ON THE PROJECT?
B. ARE YOU AWARE OF THE
HOW OFTEN?
DOES THE CONTRACTOR HOLD
CONTRACTOR'S EEO POLICIES?
YES
NO
YES
NO
REGULAR EEO MEETINGS?
WHO CONDUCTS THE MEETINGS?
WHO IS THE EEO OFFICER FOR YOUR EMPLOYER? WHO IS THE EEO OFFICER FOR THE PROJECT?
C. ARE YOU INTERESTED IN / OR HAS YOUR EMPLOYER INFORMED YOU OF UPGRADING
IF YES, PLEASE EXPLAIN
YES
NO
AND TRAINING POSSIBILITIES?
4.
EMPLOYEE COMMENTS
NAME OF INTERVIEWER (PRINT)
DATE
SIGNATURE OF INTERVIEWER
5. INTERVIEWER'S COMMENTS
NAME OF RESIDENT ENGINEER (PRINT)
DATE
SIGNATURE OF RESIDENT ENGINEER
FM 91 1282
91 61116
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONFIDENTIAL
EMPLOYEE INTERVIEW: LABOR COMPLIANCE / EEO
This document contains personal information and subject to
Civil Code 1798.24, it shall be kept confidential in order to
CEM-2504 (REV 05/2020) CT #7541-3512-3
protect against unauthorized disclosure.
FED NO.
CONTRACT NO.
INSTRUCTIONS - (SEE REVERSE SIDE)
1.
QUESTIONS TO BE ASKED OF EMPLOYEE
EMPLOYEE NAME
LABOR CLASSIFICATION
EMPLOYEE ADDRESS
PHONE
DIR BASE WAGE (Filled in by Labor Compliance)
BASE RATE
FRINGE BENEFITS (Filled in by Labor Compliance)
PRIME CONTRACTOR
EMPLOYER
WORK BEING PERFORMED AT TIME OF INTERVIEW
IF OPERATOR, WHAT TYPE OF EQUIPMENT?
A. HOW LONG HAVE YOU WORKED FOR YOUR PRESENT EMPLOYER? HOW LONG ON THIS PROJECT?
B. DESCRIBE THE TYPE OF WORK YOU HAVE BEEN DOING THIS PAST WEEK
C. WHAT IS YOUR WAGE [Include Base and Fringe Benefits (Compare to Payroll)]
DO YOU KEEP A RECORD OF THE HOURS YOU WORK?
YES
NO
D. DO YOU WORK OVERTIME?
IF NO, EXPLAIN
ARE YOU PAID TIME AND
FREQUENTLY
SELDOM
NONE
ONE-HALF FOR OVERTIME?
YES
NO
2.
TRAVEL
DRIVE OR RIDE IN COMPANY VEHICLE TO WORK SITES?
HOW MANY MILES DO YOU TRAVEL TO WORK?
DRIVE
RIDE
NEITHER
ARE YOU REQUIRED TO REPORT TO THE YARD FIRST?
DO YOU DRIVE A PERSONAL VEHICLE TO WORKSITES?
YES
NO
YES
NO
3.
EEO
YES
NO
A. HAVE YOU SEEN THE REQUIRED WAGE RATE POSTERS ON THE PROJECT?
B. ARE YOU AWARE OF THE
HOW OFTEN?
DOES THE CONTRACTOR HOLD
CONTRACTOR'S EEO POLICIES?
YES
NO
YES
NO
REGULAR EEO MEETINGS?
WHO CONDUCTS THE MEETINGS?
WHO IS THE EEO OFFICER FOR YOUR EMPLOYER? WHO IS THE EEO OFFICER FOR THE PROJECT?
C. ARE YOU INTERESTED IN / OR HAS YOUR EMPLOYER INFORMED YOU OF UPGRADING
IF YES, PLEASE EXPLAIN
YES
NO
AND TRAINING POSSIBILITIES?
4.
EMPLOYEE COMMENTS
NAME OF INTERVIEWER (PRINT)
DATE
SIGNATURE OF INTERVIEWER
5. INTERVIEWER'S COMMENTS
NAME OF RESIDENT ENGINEER (PRINT)
DATE
SIGNATURE OF RESIDENT ENGINEER
FM 91 1282
91 61116
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EMPLOYEE INTERVIEW: LABOR COMPLIANCE / EEO
CEM-2504 (REV 05/2020) CT #7541-3512-3
DIRECTIONS TO INTERVIEWER
1. Fill in Section 1 completely, from interview responses.
2. Fill in Section 1 DIR Base Wage, Base Rate, and Fringe Benefits from Payroll
Records, if available.
3. Fill in Section 2 completely (does not apply to owner operators).
4. Fill in Section 3 completely, from interview responses.
5. Employee comments optional in Section 4.
6. Interviewer comments on findings and recommends further actions to be taken.
Attach additional sheets if necessary.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
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