Public Works Payroll Reporting Form
A public works payroll reporting form is a document prepared by the department of industrial relations. If properly filled it satisfies the requirements of the labor code to file payrolls submitted in connection with contracts for public works and maintenance contracts. Below is a sample public works payroll reporting form.
Sample Public Works Payroll Reporting Form
Name of contractor________________ Contractors license__________ Address___________
Name of sub-contractor_________ Contractor license_________ Address_________
Payroll no._______ Self insured policy no: ________Workers compensation policy no: ______
Name of employee, address and social security No: ____________________________________
Work classification___________ Hourly rate of pay________ Taxable rate of pay__________
Gross amount earned____________ Deductions, contributions and payments_______________
Additional payment__________ Net wages paid per week_________
Check no: _______
Worker class code_____________ No. of withholding exemptions________
I the (Name) ______________undersigned (position in business) __________________ with the authority to act on behalf of _____________that the records submitted are originals and copies of actual disbursement to the individual named.
Name_________________ Date__________ Signature______________
Category: Payroll Forms
