EZ (Fax) Form EZ (Fax) Form

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

CompanyName__________________________________________
OESSurveyScheduleNumber_______________________________
ContactPerson__________________________________________
Email__________________________________________________

Instructions:
Telephone___________________Fax_______________________
1) 5HSRUW part time workersat an hourly rate.)XOOWLPHZRUNHUVFDQEHUHSRUWHGE\WKHLUDQQXDORUKRXUO\UDWH
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 $QQXDORU+RXUO\5DWHIRU)XOOWLPH:RUNHUV5HSRUW+RXUO\5DWHIRUPart-time Workers)
A

B

C

D

E

F

G

H

I

J

K

L

Hourly

under
$9.25

$9.25 11.74

$11.75 14.74

$14.75 18.74

$18.75 23.99

$24.00 30.24

$30.25 38.49

$38.50 48.99

$49.00 61.99

$62.00 78.74

$78.75 99.99

$100.00
and over

Annual

under
$19,240

$19,240 24,439

$24,440 30,679

$30,680 38,999

$39,000 49,919

$49,920 62,919

$62,920 80,079

$80,080 - $101,920 - $128,960 - $163,800 - $208,000
101,919
128,959
163,799
207,999
and over

OccupationTitle
(Example):RegisteredNurse

Rev. 6HSW. 201

2

1

T
Total
Employment

3

Form Approved

O.M.B. No. 1220-0042