WORKER WAGE RATE NOTIFICATION Central Health – SE Health & Wellness Center 2901 Montopolis Drive Austin, TX 78741 Project Number: 14301-0021 This form shall be used by Contractors engaged in execution of Central Health – SE Health & Wellness Center, construction contracts in accordance with the Prevailing Wage Guidelines and the requirements of the Uniform General and Supplementary General Conditions or the Contract. This notice must be delivered and signed by all workers involved in the project and must list both monetary wages and fringe benefits required to be paid to the worker. For workers engaged in multiple classifications, submit separate Wage Notification forms for each classification upon the beginning of such work. Workers who believe they are misclassified or are being paid an incorrect wage/fringe should direct their questions to their employer. If a worker feels their questions are not resolved, questions may be directed to the Prime Contractor at (512)326-4223. Este formulario será utilizada por los contratistas contratados en ejecución de Central Health – SE Health & Wellness Center, contratos de construcción de acuerdo con las directrices de salarios vigentes y los requisitos del General de uniforme y complementario de las condiciones generales o el contrato. Este aviso debe ser entregado y firmado por todos los trabajadores involucrados en el proyecto y debe enumerar salarios monetarios y beneficios debe ser pagada al trabajador. Para los trabajadores que participan en múltiples clasificaciones, presentar formas separadas de la notificación de salario para cada clasificación al comienzo de dicho trabajo. Trabajador que creen que están mal clasificados o que se les paga un salario incorrecto / franja debe dirigir sus preguntas a su empleador. Si un trabajador se siente a sus preguntas no se resuelven, las preguntas pueden ser dirigidas al contratista principal, al (512)326-4223.
Project: Central Health – SE Health & Wellness Center Proyecto:
Prime Contractor: Bartlett Cocke General Contractors, LLC
Employee Name: (printed) _________________________________________ Nombre De Empleado: (deletreado)
Last Four Digits of Your Social Security Number: __________
Worker Classification: (for this project)___________________
Últimos Cuatro Dígitos de su Número de Seguridad Social:
Clasifcacion De Trabajo: (para este proyecto)
Wage Rate Required:
Base Rate:
Fringe Benefits:
Total:
(Health/Pension/Vacation) Salario Requerido:
Sueldo de Base:
Franja Beneficios: (Salud/Pension/Vacacion)
Total:
$__________
$__________
$__________
$__________
$__________
$__________
(per contract wage schedule) (por el contrato de salario)
Actual Wages Paid: Salario Actualmente Pagado
(per employment agreement) (por contrato de empleo)
As the EMPLOYEE NAMED ABOVE, I hereby acknowledge receipt of this notice and by my signature below indicate my agreement with both the Classification of work to which I have been assigned on this project and to the wages proposed to be paid to me for such work. Come el EMPLEADO NOMBRADO ARRIBA, Yo reconozco el recibo de esta noticia y con mi firma, indico mi arreglo con la Clasificacion de empleo al cual he sido designado en este proyecto y al salario propuesto ha ser pagado a mi por dicho trabajo.
________________________________ _ Employee Signature Firma de Empleado Date: Fecha:_______________________________
Attest:
Approved:
________________________________ _ Employer Representative’s Name (Printed)
Page 1 of 1. WORKER WAGE RATE NOTIFICATION. Central Health â SE Health & Wellness Center. 2901 Montopolis Drive. Austin, TX 78741. Project Number: ...
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