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  **LABOR STANDARDS                                                                                                                                      
  INTERVIEW**                                                                                                                                            

  Contract Number                                                 Employee's Name                                                                        
                                                                  *(Last, First,                                                                         
                                                                  M.I.)*                                                                                 

                                                                                                                                                         

  Name of Prime                                                   Employee's                                                                             
  Contractor:                                                     Address                                                                                
                                                                  *(Street, City,                                                                        
                                                                  State, ZIP                                                                             
                                                                  Code*)                                                                                 

                                                                                                                                                         

  Name of Employer                                                Work                                                                       Wage        
                                                                  Classification                                                             Rate        

                                                                                                                                                         

                                                                  Supervisor's                                                                           
                                                                  Name *(Last,                                                                           
                                                                  First, M.I.)*                                                                          

                                                                                                                                                         

                                                                                                                                   *(Check               
                                                                                                                                   Below)*               

                                                                                                                                   Yes                   No

  Do you work over                                                                                                                                       
  8 hours per day?                                                                                                                                       

  Do you work over                                                                                                                                       
  40 hours per                                                                                                                                           
  week?                                                                                                                                                  

  Are you paid at                                                                                                                                        
  least time and a                                                                                                                                       
  half for overtime                                                                                                                                      
  hours?                                                                                                                                                 

  Are you receiving                                                                                                                                      
  any cash payments                                                                                                                                      
  for fringe                                                                                                                                             
  benefits required                                                                                                                                      
  by the posted                                                                                                                                          
  wage                                                                                                                                                   
  determination                                                                                                                                          
  decision?                                                                                                                                              

  What deductions                                                                                                                                        
  other than taxes                                                                                                                                       
  and Social                                                                                                                                             
  Security are made                                                                                                                                      
  from your pay?                                                                                                                                         

                                                                                                                                                         

  How many hours                                                                                                                                         
  did you work the                                                                                                                                       
  day before this                                                                                                                                        
  interview                                                                                                                                              

  Hours             What date                                                                                                                            
                    *(YYMMDD)*                                                                                                                           
                    was that?                                                                                                                            

  What tools do you                                                                                                                                      
  use?                                                                                                                                                   

                                                                                                                                                         

  When did you                                                                                                                                           
  begin work on                                                                                                                                          
  this project                                                                                                                                           
  *(YYMMDD)*?                                                                                                                                            

                                                                                                                                                         

  I have read the                                                                                                                                        
  above and certify                                                                                                                                      
  it to be correct                                                                                                                                       
  to the best of my                                                                                                                                      
  knowledge.                                                                                                                                             

  Employee's                                                                                                    Date                                     
  Signature                                                                                                     *(YYMMDD)*                               

                                                                                                                                                         

  Interviewer's                                                                                                 Date                                     
  Signature                                                                                                     *(YYMMDD)*                               

                                                                                                                                                         

  **INTERVIEWER'S                                                                                                                                        
  COMMENTS**                                                                                                                                             

  Work employee was                                                                                                                                      
  doing when                                                                                                                                             
  interviewed:                                                                                                                                           

                                                                                                                                                         

  Is the employee                                                                                                            Yes                    No   
  property                                                                                                                                               
  classified and                                                                                                                                         
  paid? (If                                                                                                                                              
  additional space                                                                                                                                       
  is needed, use                                                                                                                                         
  comments section)                                                                                                                                      

                                                                                                                                                         

  Are wage rates                                                                                                                                         
  and posters                                                                                                                                            
  displayed?                                                                                                                                             

  **FOR USE BY                                                                                                                                           
  PAYROLL CHECKER**                                                                                                                                      

  Is above                                                                                                                   Yes                    No   
  information in                                                                                                                                         
  agreement with                                                                                                                                         
  payroll data?                                                                                                                                          

                                                                                                                                                         

  Comments                                                                                                                                               

                                                                                                                                                         

  Date of Check                  Name of Checker *(Last,  Job                                 Signature                                                  
  *(YYMMDD):*                    First, M.I.)*            Title                                                                                          

                                                                                                                                                         
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