Form PC-1A Idhr Employer Location(S) Report Form - Illinois

Form PC-1A or the "Idhr Employer Location(s) Report Form" is a form issued by the Illinois Department of Human Rights.

Download a PDF version of the Form PC-1A down below or find it on the Illinois Department of Human Rights Forms website.

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IDHR Employer Location(s) Report Form (PC-1A)
Submit this form via Email to:
IDHR.PublicContracts@Illinois.gov
State of Illinois
Or via mail to:
Illinois Department of Human Rights
IDHR - PUBLIC CONTRACTS UNIT
100 W. RANDOLPH ST - SUITE 10-100
Legal Division, Public Contracts Unit
CHICAGO, IL 60601
Note: If the Illinois location has a different FEIN from the corporate office, do not complete this form.
Vendor On-Line Registration
Proceed to the
Page to apply for an IDHR Eligibility Number and pay
the $75.00 registration fee using a credit card. To pay via mail, submit a properly completed, signed
form to IDHR Fiscal Unit, 100 W Randolph St., Suite 10-100, Chicago, IL 60601 accompanied by a
certified check, money order, or cashier's check for $75 payable to the Illinois Department of Human
Rights.
Instructions: This form is to be used by an entity to add or renew an Illinois Location to an existing
IDHR Eligibility Number (out-of-state locations cannot register). If your entity has multiple Illinois
locations that all have the same Federal Employer Identification Number (FEIN), you are not
obligated to pay an additional fee to receive an IDHR number for any locations having the same
FEIN and wishing to be eligible to bid on business with the State of Illinois. IDHR Location Eligibility
Numbers expire five years after the date of issue and may be renewed at the same time that the
corporate entity IDHR number is renewed for a $75 fee. No additional fee is required to add
locations. Forms received with the employment data omitted will not be processed. The information
is necessary to comply with the statutory provisions set forth in
775 ILCS 5/1-101 et seq.
Disclosure
of this information is REQUIRED.
The gathering and retention of employee race/ethnicity and
gender data is permitted by State and federal law so long as such data is kept separate from other
personnel information and is not used for the purpose of engaging in unlawful discrimination. For
44 Il Admin code, Section 750.210(a).
administrative details, review
You must have an IDHR Eligibility Number if your company wants to be eligible to bid on State
contracts and any one of the following applies:
1) your company employs 15 or more persons at the time of application for a public contract;
2) your company has employed 15 or more persons at any time during the 365 day period prior to the
date of your applying for the public contract;
3) you are directed to file by a contracting agency of the State of Illinois, any political subdivision, or
municipal corporation.
A form is deemed filed when it is received by the IDHR Public Contracts Unit - Chicago Office,
PROPERLY completed and signed. An IDHR PC-1A form must be completed for EACH additional
location applying to do business with the State. No additional fee is required to add locations. This
form must be filed prior to bid opening.
The FEIN must be provided.
If your entity does not have an eligible IDHR number, please visit
www.illinois.gov/dhr/publiccontracts
to obtain a PC-1 Form or visit the
Vendor On-Line Registration
page.
IDHR EMPLOYER LOCATION(S) REPORT FORM 6/1/2016 Employer Report Form - Submit to IDHR Public Contracts Unit
Note: An Employer IDHR Eligibility Number Expires 5 years from the date of issue/renewal
IDHR Employer Location(s) Report Form (PC-1A)
Submit this form via Email to:
IDHR.PublicContracts@Illinois.gov
State of Illinois
Or via mail to:
Illinois Department of Human Rights
IDHR - PUBLIC CONTRACTS UNIT
100 W. RANDOLPH ST - SUITE 10-100
Legal Division, Public Contracts Unit
CHICAGO, IL 60601
Note: If the Illinois location has a different FEIN from the corporate office, do not complete this form.
Vendor On-Line Registration
Proceed to the
Page to apply for an IDHR Eligibility Number and pay
the $75.00 registration fee using a credit card. To pay via mail, submit a properly completed, signed
form to IDHR Fiscal Unit, 100 W Randolph St., Suite 10-100, Chicago, IL 60601 accompanied by a
certified check, money order, or cashier's check for $75 payable to the Illinois Department of Human
Rights.
Instructions: This form is to be used by an entity to add or renew an Illinois Location to an existing
IDHR Eligibility Number (out-of-state locations cannot register). If your entity has multiple Illinois
locations that all have the same Federal Employer Identification Number (FEIN), you are not
obligated to pay an additional fee to receive an IDHR number for any locations having the same
FEIN and wishing to be eligible to bid on business with the State of Illinois. IDHR Location Eligibility
Numbers expire five years after the date of issue and may be renewed at the same time that the
corporate entity IDHR number is renewed for a $75 fee. No additional fee is required to add
locations. Forms received with the employment data omitted will not be processed. The information
is necessary to comply with the statutory provisions set forth in
775 ILCS 5/1-101 et seq.
Disclosure
of this information is REQUIRED.
The gathering and retention of employee race/ethnicity and
gender data is permitted by State and federal law so long as such data is kept separate from other
personnel information and is not used for the purpose of engaging in unlawful discrimination. For
44 Il Admin code, Section 750.210(a).
administrative details, review
You must have an IDHR Eligibility Number if your company wants to be eligible to bid on State
contracts and any one of the following applies:
1) your company employs 15 or more persons at the time of application for a public contract;
2) your company has employed 15 or more persons at any time during the 365 day period prior to the
date of your applying for the public contract;
3) you are directed to file by a contracting agency of the State of Illinois, any political subdivision, or
municipal corporation.
A form is deemed filed when it is received by the IDHR Public Contracts Unit - Chicago Office,
PROPERLY completed and signed. An IDHR PC-1A form must be completed for EACH additional
location applying to do business with the State. No additional fee is required to add locations. This
form must be filed prior to bid opening.
The FEIN must be provided.
If your entity does not have an eligible IDHR number, please visit
www.illinois.gov/dhr/publiccontracts
to obtain a PC-1 Form or visit the
Vendor On-Line Registration
page.
IDHR EMPLOYER LOCATION(S) REPORT FORM 6/1/2016 Employer Report Form - Submit to IDHR Public Contracts Unit
Note: An Employer IDHR Eligibility Number Expires 5 years from the date of issue/renewal
IDHR Employer Location(s) Report Form (PC-1A)
Submit this form via Email to:
IDHR.PublicContracts@Illinois.gov
State of Illinois
Or via mail to:
Illinois Department of Human Rights
IDHR - PUBLIC CONTRACTS UNIT
100 W. RANDOLPH ST - SUITE 10-100
Legal Division, Public Contracts Unit
CHIAGO, IL 60601
Adding a location to a new or existing IDHR Number.
Renewing a location to a new or existing IDHR Number.
IDHR Number (If renewing or adding location):
FEIN (required):
Name of Applying Company:
Address:
City:
State:
ZIP:
County:
Country:
Contact Name:
Contact Phone:
E-mail:
Does the company have a current, written sexual harassment policy?
Yes
No
Within the past three years, has the company been declared ineligible for any public contract based
No
Yes
on a finding of employment discrimination? If yes, attach a separate sheet fully explaining the
situation.
In the chart below, enter the racial and gender breakdown of the employees of the company, or the branch/location of the
company/organization applying to be eligible to bid on contracts for the State of Illinois.
Asian/Pacific
White
Black
Hispanic
American Indian
Totals
Islander
Male
Female
Total
By checking this box, I certify that the information provided in this report, and in any attachments thereto, is
true and accurate to the best of my knowledge and belief. The employer filing this report agrees to
conform with the requirements set forth in the Illinois Human Rights Act, 775 ILCS 5/1-101 et seq., and the
rules and regulations of the Department of Human Rights. I am authorized to submit this form on behalf of
the employer.
Typed Name / Title of the person completing this form
Date this form was completed
IDHR EMPLOYER LOCATION(S) REPORT FORM 6/1/2016 Employer Report Form - Submit to IDHR Public Contracts Unit
Note: An Employer IDHR Eligibility Number Expires 5 years from the date of issue/renewal
Definitions, Clauses and Policies
State of Illinois
Applicable to the IDHR Employer Report Form
Illinois Department of Human Rights
Legal Division, Public Contracts Unit
Keep for your Records
Definition of employee -
For purposes of this form, an “employee” is an individual performing services for remuneration for the employer. All full-time and
Forms received containing mathematic errors will not be processed.
permanent part-time employees are to be reported.
Description of Race/Ethnic -
Race/ethnic designations as used by the Department do not denote scientific definitions of anthropological origins. For the
purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as
belonging. However, no person should be counted in more than one race/ethnic group. They are:
“White (Not of Hispanic Origin)”
All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
“Black or African-American”
(Not of Hispanic Origin). All persons having origins in any of the Black racial groups of Africa.
“Hispanic or Latino”
All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
“Asian or Pacific Islander”
All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific
Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa.
“American Indian or Alaskan Native”
All persons having origins in any of the original peoples of North America, and who maintain cultural identification
through tribal affiliation or community recognition.
Definition of categories -
Each employee should be counted in only one job category. Select the category containing the jobs most similar to that performed
by the employee. The jobs listed in each category are intended to provide examples, not a complete list, of all job titles falling into that category.
“Executive Senior Level Officials”
Individuals who plan, direct and formulate policies, set strategy and provide the overall direction of enterprises/
organizations for the development and delivery of products or services, within the parameters approved by boards of directors or other governing bodies.
Examples include: chief executive officers, chief operating officers, chief financial officers, line of functional areas or operating groups, chief information
officers, chief marketing officers, chief legal officers, management directors and managing partners.
“First/Mid Level Officials and Managers”
Individuals who typically lead major business units. They implement policies, programs and directives of
executive/senior management through subordinate managers and within the parameters set by Executives/Senior Level management. Examples of these
kinds of managers are: first-line managers, team managers, unit managers, administrative services managers, purchasing and transportation managers, call
center or customer service managers, technical support managers, and brand of product managers.
“Professionals”
Occupations requiring either college graduation or experience of such kind and amount as to provide a comparable background. Includes:
accountants and auditors, airplane pilots and navigators, architects, artists, scientists, designers, dietitians, editors, engineers, lawyers, librarians,
mathematicians, registered professional nurses, personnel and labor relations specialists, physicians, social scientists, teachers, surveyors etc.
“Technicians”
Occupations requiring a combination of basic scientific knowledge and manual skill which can be obtained through 2 years of post high school
education, such as is offered in many technical institutes and union colleges, or through equivalent on-the-job training. Includes: computer programmers,
drafters, engineering/mathematical/scientific aides, licensed/practical/vocational nurses, photographers, radio operators, technical illustrators, medical/dental/
electronic/scientific technicians, etc.
“Sales Workers”
Occupations engaging wholly or primarily in direct selling. Includes: advertising agents and sates workers, insurance agents and brokers,
real estate agents and brokers, stock and bond sales workers, demonstrators, sales workers and sales clerks, grocery clerks, and cashiers/checkers, etc.
“Administrative Support Workers”
Includes all clerical-type work regardless of level of difficulty, where the activities are predominantly non-manual though
some manual work not directly involved with altering or transporting the products is included. Includes: bookkeepers, collectors (bills and accounts),
messengers and office helpers, office machine operators (including computer), shipping and receiving clerks, stenographers, typists and secretaries,
telegraph and telephone operators, legal assistants, etc.
“Craft Workers (skilled)”
Manual workers of relatively high skill level having a thorough and comprehensive knowledge of the processes involved in their
work.
Exercise considerable independent judgment and usually receive an extensive period of training.
Includes: the building trades, hourly paid
supervisors/lead operators not members of management, mechanics, skilled machinists, electricians, compositors/typesetters/engravers, pattern/model
makers, stationary engineers, motion picture projectionists, painters (construction/maintenance), tailors/tailoresses, arts/decorating occupations,
handpainters, coaters, bakers, etc.
“Operatives (semiskilled)”
Workers who operate machine or processing equipment or perform other factory-type duties of intermediate skill level which can
be mastered in a few weeks and require only limited training. Includes: apprentices (auto/plumbing/bricklaying/carpentry/electrical/machinist/mechanical/
building trade/metalworking/printing trades, etc.), attendants (auto service/parking), blasters, chauffeurs, delivery workers, sewers/stitchers, dryers, furnace
workers, heaters, laundry/dry cleaning, milliners, mine laborers, motor operators, oilers/greasers (except auto), painters (manufactured articles),
photographic processors, truck/tractor drivers, welders/flame cutters, electronic equipment assemblers, butchers/meatcutters, inspectors/testers/graders,
handpackers/packagers, knitting/looping/taping/weaving machine operators, etc.
“Laborers & Helpers”
Workers in manual occupations which generally require no special training who perform elementary duties that may be learned in a few
days and require the application of little or no independent judgment.
Includes: garage laborers, car washers/greasers, gardeners, farm workers,
stevedores, wood choppers, lifting/digging/mixing/loading/pulling laborers, etc.
“Service Workers”
Workers in both protective and non-protective service occupations. Includes: attendants (hospital/other institutions, professional/personal
service, nurses aides/orderlies), barbers, char workers/cleaners, cooks, counter/fountain workers, elevator operators, firefighters/fire protection, guards,
doorkeepers, stewards, janitors, police officers/detectives, porters, waiters/waitresses, amusement/recreation facilities attendants, guides, ushers, public
transportation attendants, etc.
(IDHR EMPLOYER REPORT FORM 1/30/2015) Definitions, Clauses and Policies - Keep for your records
Definitions, Clauses and Policies
State of Illinois
Applicable to the IDHR Employer Report Form
Illinois Department of Human Rights
Legal Division, Public Contracts Unit
Keep for your Records
ILLINOIS ADMINISTRATIVE CODE
FEDERAL EXECUTIVE ORDER 11246
EQUAL EMPLOYMENT OPPORTUNITY CLAUSE
The
Executive Order 11246 (E.O 11246)
prohibits federal contractors and
44 Ill.
Admin. Code, Section 750. APPENDIX
A.
Equal Employment
subcontractors
and
federally-assisted
construction
contractors
and
subcontractors that generally have contracts that exceed $10,000 from
Opportunity Clause
discriminating in employment decisions on the basis of race, color, religion,
sex, or national origin. It also requires covered contractors to take affirmative
EQUAL EMPLOYMENT OPPORTUNITY
action to ensure that equal opportunity is provided in all aspects of their
employment.
In the event of the contractor's non-compliance with the provisions of this
Equal Employment Opportunity Clause, the Illinois Human Rights Act or the
The
E.O.
11246
is
administered
by
the
Employment
Standards
Rules and Regulations of the Illinois Department of Human Rights
Administration's Office of Federal Contract Compliance Programs (OFCCP)
("Department"), the contractor may be declared ineligible for future contracts
within the U.S. Department of Labor.
or subcontracts with the State of Illinois or any of its political subdivisions or
municipal corporations, and the contract may be canceled or voided in whole
WRITTEN SEXUAL HARASSMENT POLICY REQUIRED
or in part, and such other sanctions or penalties may be imposed or remedies
invoked as provided by statute or regulation. During the performance of this
Illinois law requires all parties to a public contract and all eligible bidders to
contract, the contractor agrees as follows:
have a written sexual harassment policy covering their employees and
1) That it will not discriminate against any employee or applicant for
applicants for employment.
This requirement applies regardless of the
employment because of race, color, religion, sex, marital status, national
number of persons employed or the dollar value of any public contract.
origin or ancestry, age, physical or mental handicap unrelated to ability, or an
unfavorable discharge from military service; and further that it will examine all
This requirement is found at
775 ILCS
5/2-105(A)(4).
Each sexual
job classifications to determine if minority persons or women are underutilized
harassment policy must contain the following elements:
and will take appropriate affirmative action to rectify any such underutilization.
2) That, if it hires additional employees in order to perform this
1.
A statement that sexual harassment is illegal.
contract or any portion thereof, it will determine the availability (in accordance
2.
The definition of sexual harassment under the Illinois Human Rights
with the Department's Rules) of minorities and women in the area(s) from
Act.
which it may reasonably recruit and it will hire for each job classification for
3.
A description of the acts that constitutes sexual harassment, with
which employees are hired in such a way that minorities and women are not
examples.
underutilized.
4.
The vendor's internal complaint procedure, including penalties.
3) That, in all solicitations or advertisements for employees placed
5.
The legal recourse, investigative, and complaint process available
by it or on its behalf, it will state that all applicants will be afforded equal
through the Illinois Department of Human Rights and the Illinois Human
opportunity without discrimination because of race, color, religion, sex, marital
Rights Commission.
status, national origin or ancestry, age, physical or mental handicap unrelated
6.
Information as to how a person can contact the Department and the
to ability, or an unfavorable discharge from military service.
Commission.
4) That it will send to each labor organization or representative of
7.
Information regarding the protection against retaliation under
workers with which it has or is bound by a collective bargaining or other
Section 6-101 of the Human Rights Act.
agreement or understanding, a notice advising such labor organization or
representative of the contractor's obligations under the Illinois Human Rights
A copy of the employer's policy must be submitted to the Department or to a
Act and the Department's Rules. If any such labor organization or
contracting agency upon request.
representative fails or refuses to cooperate with the contractor in its efforts to
comply with such Act and Rules, the contractor will promptly so notify the
Employers can obtain a Model Sexual Harassment Policy by contacting the
Department and the contracting agency and will recruit employees from other
Department.
sources when necessary to fulfill its obligations thereunder.
___________________________
5) That it will submit reports as required by the Department's Rules,
furnish all relevant information as may from time to time be requested by the
DISCRIMINATORY CLUB ACT
Department or the contracting agency, and in all respects comply with the
Illinois Human Rights Act and the Department's Rules.
Pursuant to
775 ILCS 25/0.01 et
seq., no private organization selling goods
6) That it will permit access to all relevant books, records, accounts
or services to the State or receiving any award or grant from the State, nor
and work sites by personnel of the contracting agency and the Department for
any public body, may pay any dues or fees on behalf of its employees or
purposes of investigation to ascertain compliance with the Illinois Human
agents or may subsidize or otherwise reimburse them for payments of their
Rights Act and the Department's Rules.
dues or fees to any discriminatory club. A “discriminatory club” includes any
7) That it will include verbatim or by reference the provisions of this
club, society, organization, or association, which discriminates in its
clause in every subcontract it awards under which any portion of the contract
membership policy or in access to its services or facilities. Facilities that are
obligations are undertaken or assumed, so that such provisions will be
distinctly private in nature, such as restrooms and shower rooms, are exempt
binding upon such subcontractor. In the same manner as with other
as to discrimination based on sex.
provisions of this contract, the contractor will be liable for compliance with
applicable provisions of this clause by such subcontractors; and further it will
promptly notify the contracting agency and the Department in the event any
subcontractor fails or refuses to comply therewith. In addition, the contractor
will not utilize any subcontractor declared by the Illinois Human Rights
Commission to be ineligible for contracts or subcontracts with the State of
Illinois or any of its political subdivisions or municipal corporations.
(IDHR EMPLOYER REPORT FORM 1/30/2015) Definitions, Clauses and Policies - Keep for your records

Download Form PC-1A Idhr Employer Location(S) Report Form - Illinois

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