EZ (Fax) Form EZ (Fax) Form

Occupational Employment Statistics Report
In Cooperation with the U.S. Department of Labor

Form Approved, O.M.B. No. 1220-0042

Company Name__________________________________________
OES Survey Schedule Number_______________________________
Contact Person__________________________________________  

Space for State Contact Information

Email:__________________________________________________
Instructions:
Telephone___________________    Fax_______________________
1) If your employees are part time workers, please report them at an hourly rate.
2) Report each employee by occupational title. Report an employee who works in two or more occupations in the job that requires the
highest skill level. If there is no measurable difference in skill, report the employee in the occupation in which they spend the most time.
3) If you require additional space, please copy this page and submit it with your fax.
4) Please fax form back to the fax number listed above.
NUMBER OF EMPLOYEES IN SELECTED WAGE RANGES
(Report Part-time Workers According to an Hourly Rate)
A

B

C

D

E

F

G

H

I

J

K

L

Hourly

under
$9.25

$9.25 11.49

$11.50 14.49

$14.50 18.24

$18.25 22.74

$22.75 28.74

$28.75 35.99

$36.00 45.24

$45.25 56.99

$57.00 71.49

$71.50 89.99

$90.00
and over

Annual

under
$19,240

$19,240 23,919

$23,920 30,159

$30,160 37,959

$37,960 47,319

$47,320 59,799

$59,800 74,879

$74,880 94,119

$94,120 - $118,560 - $148,720 - $187,200
118,559
148,719
187,199
and over

Occupation Title
(Example):  Registered Nurse

Rev. April 2010

2

1

T
Total
Employment

3