' ' I ,I Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS CITY OF SAN DIEGO Purchasing & Contracting Departm1 Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 COMPANY INFORMATION /NFORMAC/ON SOBRE LA COMPANiA Company Name: Nombre de la Com afJfa: Company Address: Direcci6n de la Com aflia: Company Phone: Teletono de la Com aflia: Work Site Address: Sitio de Traba ·o: / lf u Supervisor Name: S • . t d t vG " Your Name: Su Nombre: Address: Direccion: '---'. Telephone number Home: Residencia: , Numero de te/etono Hourly Rate Paid: Sue/do or hora: Current job title: Titulo de Traba 'o: Do you receive health benefits? t,Recibe usted beneficios medicos? ,/ EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: · Numero de Seguridad Social: . v' '- f '<# . ( u• u Use reverse side if need Use el reverso sire ure de mas es a /I - Signature · t-trma Ciel tmpJeado FOR OFFICIAL CITY USE ONLY PARA LA OF/CINA E LA-'lllDJJ.D__SJJJ.AMENTE_ _ _ _ _ _ _ _ __ I.• I•·• I LWO Anal st: Contract Number: Send form to; EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS .WorkSiteAddress: ._,1 \Q· Sftio de Traba·o: \'-\ Supervisor Name: Superintendente!Gerente: _ --\.- . . ., .1-\ ~\ CITY OF SAN DIEGO Purchasing & Contracting Departm1 Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 e\ . "\r-.. "'- <;2~~ .lf\...:::)\_(...A \I ' '\ Your Name: ' Social Security Nu.rnber. ~s_u~M~'ombra;-·_._:~,__.~-~·~·---·~.........-~~-~·~~~~~~~-Ni_u_m_~~o_de~Segµndali=·Se_•··Cfal:._·~·~~~~~~~~~ Address: /""'\ - Direccion: _ Telephone number Kome: Numero de telefono Residenaa: Hourly Hate Paid: ' Sue/do or hora: . ·Current job title: ~A.... ~ ~ , ~ 6-B I Work: Traba'o: Overtime gate Paid: Sue/do or horas extras: How long have you worked for this company? r") n ~Ti_itu_~_d_e_Ti_ra_ba~o_:_'tl....J~\~~'-c:::::i~~'~~~3'(._)...)~-c..i~~~~~~~·~c_ua_'n_~~n~o-~_u_·en_e_m_ab_a~o~ ara~~a~mpa~a?Q!J:J~~ Do yo~ receive health ~ne~? ? \\,es If Yes, how much do you pay for your benefiis? 'ecihf;J1$~ hef.1eQCios mm1cos. 'C . _. . ·Si S' waato le f!oce p por S11S beneficios? 'I ~ C-2(1\(~ ~ M~ {~ (]- c ~ ~ .=>a~~ifneede = I rn \ D' mo. . ~ Use el reverso si requre de mas espac1 /l 0 if1n"t"r" a U v '1~1 l0ate of Receipt: ' ~ Icl·,..,,., c:...,,.,i,,,"'dO llllG -d"f v L..111/JIVU LWO Analyst: -\/\~)Ql Date· Fecha ~Number: Send form to: EMPLOYEE COMPLAINT FORM FORMULAR/O DE QUEJAS CITY OF SAN DIEG( . Purchasing & Contracting De ' Living Wage Administra ', 1200 Third Avenue, Suite ! San Diego, CA 92101 ', COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com af1fa: Company Address: Direcci6n de la Compafiia: Company Phone: Te/Mono de fa Compafifa· Work Site Address: Sitio de Traba ·a: Supervisor Name: Superintendente/Gerente: , Your Name: Su Nombre: Address: Direccion: 5 Telephone number Home: Numero de teletono Residencia· Hourly Rate Paid: Sue/do or hara: Current job title: Tftu/o de Traba'o: Do you receive health benefits? ;,Recibe usted beneficios medicos? i EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: .Vumero de Seguridad Social: Work: ~ - ' 'j!rabajo: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? ·.Cuan Jar o le tiene traba '6 ara esta com afif&? :;': C/M ( If Yes, how much do you pay for your benefits? t,Si Sf, cuanto le hace pa a por sus beneficios? '!!'ft~~~~~~ r---~~~~~~~~~~~~~~~~I Use reverse side if nee '· Use el reverso si re ure de mas es , \ / Signature · Firma def Empleado LWO Anal st: Date · Fecha Contract Number: ,..··· Send form to: EMPLOYEE COMPLAINT FORM FORMULAR/O DE QUEJAS · CITY OF SAN DIEGO Purchasing &Contracting Dep Living Wage AdministraU 1200 Third Avenue, Suite . San Diego, CA 92101 COMPANY.INFORMATION INFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com af1fa: Company Address: Direcci6n de la Com an/a: Company Phone: Teletono de la Compaiiia: Work Site Address: Sitio de Traba'o: Supervisor Name: Superintendente/Gerente: ,_ ' ( ·'d. ·;) . 7 t/[J . ,., •·$·:· ' ) .--/ I - •·,· / : Your Name: Su Nombre: Address: Direccion: Telephone number Home: Numero de telefono Residencia: Hourly Rate Paid: c/ r) '7 Sue/do or hara: J, -y.. ::> Current job title: /.,, Tftulo de Traba 'o: If e -i.A ct. I ,,U ~, Do you receive health benefits? J,. o ~Recibe usted beneficios medicos? ...;> ( EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: !'- Cf.l(Jmero de Seguridad Social: Work: \ Traba'o: Overtime Rate Paid: t l ( 1,,Sueldo or horas extras: How long have you worked for this company? ·Cuan Jar o le tiene traba '6 ara esta com an!a-? If Yes, how much do you pay for your benefits? ~Si Si, cuanto le hace pa a par SUS beneficios? """"""~~~'!'l'l'P!'!W'I~ ·~ i /; /' /1 II ;:?- 2 ~ -~ -e 0 '/ Date · Fecha LWO Anal st: Contract Number: 6--- (j CJ)~ -OD\ Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS . CITY OF SAN DIEGO Purchasing & Contracting Depa Living Wage Administratio1 1200 Third Avenue, Suite 21 San Diego, CA 92101 COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA l/ Company Name: n-r--:;:-· h Lt Nombre de la ComoafJla: !rUU~Y\ 0 U C:.V-~ U r-' Company Address: """'\' ::iDirecci6n de la Compafifa: I l_;j 0 \.- ~ l. u CL l (P Company Phone: . Teletono de la Compafifa: l 0 Work Site Address: J _-+-,... · I Sitio de Trabajo: CJ { S \ \- l b CJ C. l 0 \/\ SupeiVisor Name: ,_ S • . t d t /G EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO / ,,.... Your Name: Social Security Number: Su Nombre: Numero de Se uridad Social: Address: Direccion: _ Telephone number Home: Work: raba·o: Numero de teletono Residenc. Overtime Rate Paid: [f Hourly Rate Paid: . , { -:::2 Sue/do or horas extras: '2--Sue/do or hara: e....) Current job title: , ::-r--• [ "' How long have you worked for this company? Titulo de Traba·o: C\ ( ~ l \-I \Q u Ll 0 ·Guan Jar o le tiene traba '6 ara esta com afifa? Do you receive health benefits? c:_ D If Yes, how much do you pay for your benefits? i Recibe usted beneficios medicos? 0 I zSi Sf, cuanto le hace pa a par SUS beneficios? \ 4-J ¢-.er- <-/ 1J- c'-1 l L .-\ u s) d....1-/ l ;J Yv :rr.r:~~m~ir.m Use reverse side if n Use el reverso si re ure de mas e /Signature · Firma def Empleac&J LWO Anal st: Date· Fecha Contract Number: Cb8 -C>Ol •~ J' • \ Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS CITY OF SAN DIEGO Purchasing &Contracting Depa Living Wage Administratio 1200 Third Avenue, Suite 2 San Diego, CA 92101 COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com afifa: Company Address: Direcci6n de la Com afila: Company Phone: Te/Mono de la Com afiia: Work Site Address: Sitio de Traba 'o: Supervisor Name: Superintendente!Gerente: . Your Name: Su Nombre: v- I \'Address: Direccion: Telephone number Numero de telefono '--\c_--2 EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: Numero de Seguridad Socia/, r\ - . Home: Residenc ) - Current job title: Titulo de Traba'o: Do you receive health benefits? t,Recibe usted beneficios medicos? Work: Trabajo: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? ·Cuan Jar o le tiene traba '6 ara esta com aflfa? If Yes, how much do you pay for your benefits? t, Si Sf, cuanto le hace pa a por sus beneficio """"......~.....-i~~l'l't'I'!" Use reverse side if r Use el reverso sire ure de mass - ~Signature · Firma def Empleado LWO Anal st: J 8-28--0Z Date· Fecha Contract Number: ft=UJ5 -CXJ2,, . ,. .. .--···"'\·" ·• ...• Send form to: CITY OF SAN DIEGO Purchasing & Contracting Departmen L~vlng Wage Administration 12G0 Third Avenue, Suite 200 · .gari Diego, CA 92101 EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS _ ___ _ _ _ ___ - --·- - - - - -- - - CQll..4PAN:¥ i~JFQRMATfON _ - -1NFORMA-Ct6NSOBRELACOMPANiA -- -_ --- ---- _ · -= _- -- _·: --~-= -- ------ ---- Company Name: Nombre de la Com· aflfa: Company Address: Direccion de ta Com aflia: Company Phone: tf/fI Tetefono de la Com afiia~· Work Site Address: Lf c.J. q 9 Sitio de Trab ·a: Supervisor Name: Superintendente/Gereme: €1{-sr- I ~---------------------- / . .. _ Your Name: Su Nombre: Address: 61l-~ M 4 EMPLOYEE !NFORMATIO~ _ ___ INFORMACt6N SOBRE EL EMPLEADO _ _ _··Social Security Number: . Numero de Seauridad Social: ~~~~~- Direccion: - ___ : _ __ _ _________ _ -~~~~~--- I , Telephone number Homi Work: "-' .. ...,,, """ 1 ._.N_u_m_er_o_d_e_te_fefi_o_no_ _ _ Re_s_-iu_r;;r_1c_1a_:_·---------·---··-I!?M.o.;..:_---,~------------Hourly Rate Paid: / o . o o Overtime Rate Paid: Suefdo or fiora.'. Sue/do· or horas extras: Currentjob title: S eo.uf. lTJ How k:mg have you worked for this company? Cf fYl ~NT!f:J , Tiiuio de Trabab: . ·Guan la o le tlene trabcf6 araesta com 9[1ia? ·----1---Do yo.u receive ~ealth ~enen;s2 If Yes, how much do you pay for your benefits? :l-. 0 0 ·Recioo tJ.st~ nef1ftt1Jfrus l'lrtitilGP$ t . . . , "'$£ Si;.GtJimto le ha~ a a "or sus ben~tfciOs? Je,5 ~~l'r. Use reverae side if nee Use el reverso si requre de mas esp. SlH' 1a\u1e. • r1rma a~ tmpfeado~ . ?3-07 Date ··hoh,_a___ '!!!ii'!!'li!P.!'l!l'P.! Contract Number: it ;V Send form to: CITY OF SAN DIEGO Purchasing Division ·Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS Company Name: Nombre de la Com aflia: Company Address: Direcci6n de la Com afJfa: Company Phone: Te/Mono de la Com af'Jia: Work Site Address: Sitio de Traba'o: Supervisor Name: Su erintendente!Gerente: Your Name: Su Nombre: Address: Direccion: r '"' r"-: How long have you worked for this company? ,_ 0 Tftulo de Trabajo: e.. :r: -~~----- <., Cual]JE!lf_o le_tien_?_j_rabaJ6_12ara esta compaf1fa? /(;j y ;_'f>__c1_1_r._/___,_,_ __,__,___,_ ,irs7v1 rm ~se el revef'§.Q..sLre ure-denrrasesacio Date · Fecha . \' CITY OF SAN DIEGO Purchasing & Contracting Departm en Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS COMPANY INFORMATION lNFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com afiia: ,..... Company Address: Direcc/6n de la Com afiia: Company Phone: Telefono de la Com afifa: Work Site Address: Sitio de Traba o: Supervisor Name: ; 1 S . t d te/G _L l{\c.. ac e. (' 5 ~1 ·, I' -:S 8 6 · ·{- \t, 1-.0 0 3 Ce- sa '< C n· ' EMPLOYEE INFORMATION · <-.Ji _ ___ ------~-~~- ~---'-~,' -- ""' __,__ -- --INFDRMACl/J/.-t',--e cir: P1ls c:ltrct/,os v kv6 bt?S1c4s, {tt /c A.ri1a l' fh~ cs 97, . ·011tlo~ ttl'llerrOr/Ylr;;ft:: /?rm Jes vcs /YlC lY Signature · Firma def Empleado l'&M/anl'tAf de I Y-c"ela Malo -zJ11os f"i -t!/lhn./i /YJIS Date · Fecha FORCOFF1e1A1;;-e11-v-use-0Nb-'t'----~-----­ PARA LA OFICINA DE LA CIUDAD SOLAMENTE Date of Recei t: q-?- __ LWO Analyst: " I ! f I Contract Number: B, £ )Jo [(. ' 'I I Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS CITY OF SAN DIEGO Purchasing & Contracting Depart Living Wage Administration 1200 Third Avenue, Suite 20( , San Diego, CA 92101 :.. , ,_ -. : COMPANY INFORMATION · , · . , ": ' " _. . . ~-.- -" . . .-~ . INFORMACION SOBRE LA 'coMPANiA . : - . --.: ' . ·, -: . Company Name: I · NombredelaComafifa: l/ztre /_c111dsttt ;fl .Tnt!.. Company Address: . Direcci6n de la Com afila: 1 10 t.cmol) 6rtJvc.. ~a.. Company Phone: . Te/Mono de la Com afifa: I !~{) -- ;)8/ 111OC/ ~~rk Site Add.ress: Grn1c! i/a/ly ,81aad j.)m/y/ 'ctf ~ S1t10 de Trabao: 311'1 Townsqcdc tJr lfr<'a Su;:iervisor Name: ---r· . f/ S • 'tdtv'G -' - . ·" . .. ·. EMPLOYEE INFORMATION ·; ~- . -- ~ '-. . . · INFORMACION SOBRE EL EMPLEADO - ".. · I Your Name: Social Security Number: Su Nombre: Numero de Se uridad Socia/: - . - · Add~ss: Direccion: Telephone number Home: Numero de telefono Residencia: Hourly Rate Paid: . I Sue/do or hora: Current job title: Tftulo de Trabajo: Do you receive health benefits? ·Recibe usted beneficios medicos? Work: Trabajo: Overtime Rate Paid: ~ ·. I Sue/do or horas extras: bf; X fJ7() raS How long have you worked for this company? Yo 1 .clt"1J t t, Guan largo le tiene trabaj6 para esta compafliaf//to// .;JcJOY If Yes, how much do you pay for your benefits? r ·Si Si, cuanto le hace a a or sus beneficios? ;t.J /J J.tJtJ o ..,,,.~~~~~rm': t/;4.s lr~rcs N SN! a 'tJ~ tba11clo /l-1~ c/t'.JJ 1J'rr?JI) 110 1-Y1c ':M'/J 1111i Vttt!t1t'£tl11C".5 r/r ,,,,..sJc (}//ho ctliD. ltJs r&Mpqiir.ms clcJ l-At!Fi1'/c Y_l'Jhre. de/ Sbie(c(o 4'1110, kt tbn;x1111a fltJl!t.'q lt1C Use reverse side if needed '-f-rrt:ffr'A'h''/-----,<,'IH-..,,,W,&1-£1:{}-,«-14'-'7'2; 'd~ ti .,.,, ·• , . Use el re verso sf re ure de mas es acio VOt!t:lt!U!!fJt'.5· ,,,. Signaturg ~ Firmadel Empleado Date~echa l Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com afifa: Company Address: Direcci6n de la Com aflia: Company Phone: Telefono de la Com afJfa: Supervisor Name: S • . t d t /G r;, I/Id -CCt . . )nc. ( I FOCJ) :181 qq O I Cl . . . .. . l EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: Numero de Se urldad Socia/: . -.', ·'·'<; . Your Name Su Nombrr., . . ~..., ·- · · '""' - ...... Addlit3ss: ~ ,. , Direcclon: /Telephone number Home: iNu171ero dfi? teletono Resldenc 1Houriy Rate Paid: /O. /\ Sue/do por hara: · 0u l I - .. . __ -'-· _ ,. I , 1tow:::-i habaje l, • --~· ... ,-. Work: Tr.: :.:ab=-=a1i.: .·o:. . .:_ _ _ _ _ _ _ _ _ _ _ _ _ __ Overtime Rate Paid: Sue/do or horas extras: para lcL..compo.iilo Cavitem..pOW'Cj eVJ. el J-h""'-'-l.~!.U-.\.J..l:.---Ul..t.U--1--1-__Jl~l.MJ a qgo~+o 10J ::Zoo 1 OpLox!WlOdoMefd-eJ eon \lvJ S<.leldo .de.-~JIL-f20.cb.o.1L.a.._.Cuc~a Me canko.Jn lo. 'cOVV\ pa \CS_\ O.; Y\ a me. ~~ x de ~ ~~l-clw<- VJClOOdv-.'-"-t_:;,_/tJ=---=G"-'/1~.,._,,,_:J->.L.---"''--"'O'""'d'-=6_ k:t t:o m i?;er rid lfA. e Use reverse side if heeded mis ~t'nt>/:r/c:;s Use el reverso sire ure de mas es acio S~nature · Firrna def Empleado Date · Fecha FOR OFFICIAL CITY USE ONLY PARA LA OF/CINA DE LA CIUDAD SOLAMENTE Date of Recei t: · · 0 °\ LWO Anal st: µ \\S~e\,e Contract Number: " 7fG0°1·-01l. Send form to: CITY OF SAN DIEGO Purchasing &Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Address: Direcc/On"de la Com afiia: I 6 0 Company Phone: Telefono de la Com aliia: 'btq Work.Site Address: _.. . ., _J Sitio de Traba ·o: 'Cl f 0 a i:S Supervisor Name: ...,... Su erintendente!Gerente: JtJ e Cr{)t!JS()f'1 0 r.J 1 6TC. I/ er ca~ (J f1 I Cf/ q 20 2,0 44 530<'.J e /7 Your Name: Su Nombre. Ad ess: Direccion: J ~ Telephone number Home: Residencia· Numero de te/Mono Hourly Rate Paid: Sue/do or hora: Current job title: ~a,,.., _i V'\ 0 or-n Tltulo de Traba'o: 1o , •= • v Do you receive health benefits? ·Recibe usted beneficios medicos? 1. Social Security Number: Numero de Se uridad Social: ....... A - A ., ,...,. II Work: Traba}o: Overtime Rate Paid: Sue/do or horas extras: N IA How long have you worked for this company? . ·Cuan tar o le tiene traba'6 ara esta com afila? 0. - a::? If Yes, how much do you pay for your benefits? , ·Si Sf, cuanto le hace a a or sus beneficios? t-J A 8 '!!!'Pl'!'IW'!'l't'P.!l'!!!~~ll'l'l't .(?_'{\(ll/\ 1.Q. Use reverse side if needed Use el reverso sf re ure de mas es acio Signature · Firma de/ Empleado Date · Fecha J . , =;r:-coq - oIY Send form to: CITY OF SAN DIEGO Purchasing & Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 EMPLOYEE COMPLAINT FORM FORMULAR/O DE QUEJAS COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Address: , DirecciM de la Com afila: I'/ CJ Company Phone: Telefono de la Com alifa: ( 60) 3c! 7- ·- C/(}5 0 Work.Site Address: ts 4t1M t/e IM<1t4 c/c /' r. er 7 Sltio de Trabaio: (f3ft? /..ancl1s 5f SttrJ {)1r o t'/I 1Vt5" Supervisor Name: Su erintendente/Gerente: · ,··. '-·,' ··. IJ t/t4 Sctkr/l Your Name: Su Nombre: ;/ • I Ad ess: Dlreccion: Home: Telephone number Residencia. Numero de telefono Hourly Rate Paid: Sue/do or hara: Current job title: 1 Tftulo de Traba 'o: i/ t!rdI t7 t"'P't.1 · Do you receive health benefits? ·Recibe usted beneficlos medicos? f./( &J/at>ttJ ti ;)SOI -- -- ' ,,. . Vt/ -- .• , jJtP It!/,{( f""'l "if Ii-rr f'a4/ Ave S~n j)r; o C!l tfj /~;L · Social Security Number: Numero de Seguridad Social: - - , I W6rk: Traba"o: Overtime Rate Paid: Sue/do or horas extras: /l {) / J' . How long have you worked for this company? 1· 1Clft! Of' ·cuan/ar oletienetraba6 araestacom ai1ia? Nr."V ·11 Cir If Yes, how much do you pay for your benefits? ·Si Si, cuanto le hace a a or sus beneficios? ·--r - C /I '!!'Pl"!'ll'P-~~~~...... ' ......... l,,( Signature · Firma de/ Empleado LWO Anal st: 4:-' :T I--""' v u l/\ Contract Number: · . )0 ff-tY./ Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS CITY OF SAN DIEGO Purchasing & Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 COMPANY INFORMATION llVFORMACION SOBRE LA COMPANiA Your Name: Su Nombre: Ad ess: Direccion: Telephone number Home: · Numero de telefono Residencia Hourly Rate Paid: Sue/do or hara: Current job title: Tftulo de Traba'o: f 'Or ,'f1erO Do you receive health benefits? ·Recibe usted beneficios medicos? Social Security Number: Numero de Se uridad Social: I ., .,.,. "'~ • - - ...... - ff"J J)() J.., U.JO, v \ .../ Signature ·'"'f:irm'a Ckt?mp!ead6 ., Clo -00 I Thank you for taking the time to speak with me at the recent Living Wage Ordinance 5-Year Celebration. As you now know, after the LWO was enacted into law and made applicable to the San Diego Convention Center, many security and event staff subcontractors have snubbed their noses at the LWO requirements, and have successfully bid for work for conventions at rates which cannot support the payment of LWO. ~, j.JJA ·Cuanto tiem o ha traba ado ara esta com af/fa? ' If Yes, how much do you pay for your benefits? ·Si Sf, cuf}nto le hacen a ar or sus restaciones medicas? ~~f'l'l'!!!I'~~~"' ~~l '14-h ~~~~"'-l,l--l,.L--L----'-<~~::...L.j'---"J,L#.~.l.L--1-/--1--"=-l-~~'--+-L-l-l-'-'r;,,.._~;tL__L~rL!J"_~'-=,;L--,,.LLL.:..I.~~""""-_LJt_~~ J I Signature · Firma def Empleado · LWO.Analyst: .r Tbate . Fecha Contract Number: =ifoL-oo I To Whom this Concern, This letter is regarding issues that are occurring in our workplace. We believe our rights are being violated, we fear our jobs will be taking away and for this reason we wish to remain anonymous. Starting the year 2009 our two bosses, • and '., of Acasia Landscape inc. gave us, the workers, the option of getting paid holidays or receiving ten days paid vacation per calendar year. We decided to go ahead and get paid the ten days of vacation per year. In the year 2009, out of thirteen workers, only two. workers received the full paid vacations. The remaining eleven workers were only paid five days of vacation. We are now in the year 2010 and are still waiting for the rest of the promised vacation. So far we are owed 15 days of paid vacation time. When we approach our bosses about our paid time off we are turned away with insults, put downs and threats. We no longer ask for our vacations in fear that we will be laid off by our bosses. So far in the year 2010 only two workers have been paid the full ten days of vacation. We are constantly pushed to do work that is clearly too much to handle. Our bosses ask us to start working at 6:00 am and end work at 3:30 pm. In some occasions we are not allowed to take a lunch or break. We are forced to work from 6 am straight into 3 o clock none stop. These exploitations are staring to cause health problems to some of the workers. When we ask our bosses about our rights, they answer us with sarcasm, insults and more threats. We do not know what to do. If we speak out we know we will lose our jobs. We wish to be paid decently and be treated humanly and with respect. We appreciate your time and attention. Thank You o _. . n __, , .~ ,.,., , . . ,,, Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS . . ' i : - d ''. ; ·., .,.,! :.· . •) ~ j .-. \- ... ,,-, ~ . .COl'w:'f PANY INFORMATION. · ~· /NFORMACION SOBRE tA ·coMPANIA . CITY OF SAN DIEGO Purchasing & Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 · .~ . .. : .; Company Address: Direcc/6n de la Com af'lla: &:>JS West &.cm Otl vevivc 10 S' Company Phone: Telefono de la Com af/fa: Acf rwll\ .D · (l tt/) '-/SJ../-33 Qcl GIC/ -::/ :J3 - G'61J. Work Site Address: .±,. T t;Ql~ttifl1M s tc:htJl\1. ,).. Trcttn\~1 Cle(\tcr chav-Je\5 3· - TH t:' S/tio de Traba'o: 1·- .Mth 5o.: o\.c rhv \Ct Vcs-ht e(l) r¥ S. - U t!. S 0 la Jci ilct. Supervisor Name: A 1 ,o S • . t d t vG . ,, : ' . r·" .i;:EMPLOYEE INFORMATION ,. I • • . 1 ' .',• . ', • A rq . .. • ,e:·~,i:~ .1 :·:.,·. ~ ""' . ·_, ···;. 1 ":1::; . . -. ~INFOtiMACIONSOBRE.EL.EMPLEADO Your Name: Su Nombre: . ,. -··---· """''-' ~ ,.", Add1;ess: Direccion· L/ ~ _ Telephone number Home: Numero de telefono Residencia. Hourly Rate Paid: Sue/do or hora:c/5 L'.L"-\ I Current job title: Tltulo de Traba 'o: vv\ t t' ro . Do you receive health bene its? ·Recibe usted beneficios medicos? >' ..-.,1 e6 llt) (£\ n - ,. ." . , .. ·"" Social Security Number: Numero de Se uridad Socia/: Work: Traba'o: Overtime Rate Paid: 13,JD Sue/do or horas extras: How long have you worked for this company? 5C"p - 5 ~ ;;Jt!Of.Guan far o le tiene traba'6 ara esta com aiifa? Ahr/ I - l'i ·-;Joi If Yes, how much do you pay for your benefits? ·Si Si, cuanto le hace or sus beneficios? Lt ~!t'P-'PP!'!!I'~~;~ "l(ll05 ' Use reverse side if needed Use el reverso sire ure de mas es acio Signature · Firma def Emp/eado LWO Anal st: Date· Fecha ? Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION /NFORMACION SOBRELA COMPAJfJfA Company Name: Nombre de la Com atifa: Company Address: Direcci6n de la Com afifa: Company Phone: Telefono de la Com afifa: Work Site Address: Sitio de Traba ·a: Supervisor Name: Su erintendente!Gerente~· Your Name: ~ . - /~97/C/ To RR_~ Y -- 1-S_u_N_om_b_re~:=----~~·~~"' _., ,. , ,, , \I '-. . lllr" t ..I Social Security Number: N!imAm de Seauridad Social.· I __ ...,. ~ v -/ v ~~~~~--~~~~~'--1'--j Address: • Direccion: Telephone number Cf.If Home NtJmero de telefono Residencia: Hourly Rate Paid: Sue/do or hara: Current job title: re c.,0 ) eode..,.. Puesto: · Do you receive health benefits? tJ 0 ·Recibe usted prestaciones medicas? - , ''J Work: L Q\/\d_g ( q p e ~ ~Ill i Cq p 1'vi ~ Traba'o: Overtime Rate Paid: T fj£.. y 7) J {) .u lr p -6- y Sue/do or horas extras: DV . - ,,, ,,_ How long have you worked for this company?() .VE y € h~ ·Cuanto tiem o ha traba 'ado ara esta com afifa? If Yes, how much do you pay for your benefits? N/-4. ·Si Sf, cuanto le !ween a ar or sus restaciones medicas? c ~~~~~~ft' fore rncn'1. O.f ±he ·ere <:olor ~ Use reverse side if needed el reverso sire uiere de mas es ac1'o 03 ~21-/Signature · t-1rma ae1 c.111µ1t::ado LWO Anal st: Date· Fecha Contract Number: Zo/J -ttf 0\ -i-oo 1 ( O•-{- L Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPbQYEE COMPLAINT FORM FORMULARJO DE QUEJAS . 202 C Street, MS 9A, San Diego, CA 92101 Phbne (619) 236-6682 Fax (619) 533--3240 Company Name: Nombre de la Com afJ!a: Company Address: DirecckJn de la Com atlla: Company Phone: Te/etono de la Com .aflfa: Work Site Address: Sitio de Traba a: Supervisor Name: S ,. · t dent. vG rente· Q6 q ) .lJ 6«q 5 !0 J L ~ e:·) --l-V =5 lX {\ \..__ _) ", C.y { ----.... · ;.'.::;::iv'.·:~--· __,::·-._:.::;;_ . _; . ;·~~ . : :;,·~·::::".-~:\/d~?:.~~- :·:_~:;;;at::~~~EJ&~~~~f·1~~2;)0~·.:rrff~i.: Your Name: SuNombre: Address: Direction: Telephone number Nilmero de te!efono Hourly Rate Paid: Sue/do r hara: ., .:. /. :-.r:·_.- . '.. '.'";>",-t::\.:> . . ·····: S6clal Security Number: NIJmero de Se uridad Social.· Home: " ..' ~· .,, v"' · '."l - ::--=- - . ... , f-'4'...=.....~=---="'-"''-J...-'..''-'-'-----''--"''-'....._.._,,_......,._._~__,Y-~~l=q_,.C~·o~•L"•n~.rlV=""-+<~~r·r,~Or,-·~G("'l-'rLJ,_____,,+-i.µ....,.J-!-:........:.--=.>...;__i...;_,::~4-'f~ Si '1~\1R y \c;(:, !"' f\:') ~G1j Yq A-2c<1--.t~~~-l-W..L-+-~.t.L.----l 2011 . -::..:- Use reverse side If needed Use el reverso sire uiere de mas es, cio ,/~--· Date· Fecha ;;1gnatuffi.- Firma def Empleado Contract Number: LWO Analyst: .P.911029 sos 3~01S ~n~alMO do1:20 11 so 1nr ,..r·· (\) Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS .)i~i'.',;.~ ··_:"·~"')_L" . _-.-.:-: . ;·'.}: ·. :~:·_;·· .. -:.'-- ·:· '_:",«.·: · -~;.-- _, ,\qg_~.J:>~NYI~FQRMATlOW·-.-~i:J:!:~<·\:.'~:-,.... : ::.•: ·": r.;: ?. >.-•• , :. · :: -. :: " ;;_ ,., -.i::,:.~·,". Company Name: Nombre de la Compaftfa: Company Address: Direcci6n de la Comoanra: Company Phone: Telefono de la Comoanfa: Work Site Address: Sitio de Trabaio: Supervisor Name: 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 ·Fax (619) 53.3-3240 1 .·: •••. ·_ ·." :---· ... - . :'_ _· ;, ,;:._ ..-· ·~-v .> 'fNF_ORfJfAC,,/0..N.S(lBf{E LA CQMl?ANJ'A: "'!j...i:. --: . ,_: ;"• ·.· .: · ::· ,,. : .-. f<.OAJ) '3().3 W OR._ t<.-s;: -:;Lµc, ~ $/I <;p:R;71~·..... ,~f;2,,P,E£ .. . " '. 9 r::. er ,,....... ~,,·kt\ ?/69 s: .. ' . .... h·""ll: i... .. . \ . . :·~ ., . ,. . ·-: .. fo f Vv 1-fO,,v,4 ,_, S It tidti/G t 1 :,_.~,'::;-._~ .. ·::.<·:; ;'' · -: ·} -';(: '. :<~)i:,:'~:E,> :'-'_'.",'.'_-~:.::-:-- ;;!ti_MP;~9..XE~-1~F.'f?~~~I'R ~·r;;yr. ~~,;7~~:~{~-:-.:_-::~t~'.J?~(-;;;;;.~.::.:(~_ . . . ~..:- :·: ·:-.·-".... ;·· -_. ;:;( :'.:': .....· .> ".-· -~ ·-.·.•~;· _. "'ii\ ....'·:;. ·~ :,,_..> ' - :,.lf.JF08Mll€:/0,N ~.OBRE:El tiMR/j_£1;1.(JO-;.:n '·" · :... ; · '· ~· . ·: -... · "- · .- . · Your Namf'' -4 Social Security Number: . Su Nomb· _ . _ _ __ _ Address: Direccion: Home: r _.., / Telephone number Reside1 __ ,__ Numero de telefono Hourly Rate Paid: Sue/do or hara: Current job title: . l/ / Puesto: LC: I O 0 ~ Do you receive health benefits? ·Recibe usted restaciones medicas? Numero de Sequridad Social: ' r I -. .J 6,. D{,} e;; 'IL-4? / /0 (,_Q U 1.3 ~ /\..! t? D z__.:. /._ '?/I- ,t.- hi? S ~ /.J- 1.7/ /} .,,. 'D I c..:::= C 0 ,, . J /J ,t.... />, D Use reverse side If needed Use el reverso sire were de mas es ado Signature · Firma del Empleado LWO Analyst: i:i-91102:9 sos 7 lbate · Fecha _ _ _ _ _ _ _Co_ntract Number. 3~01s ~mrn1rio Send form to: CITY OF SAN DIEGO EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS . . .. .: · ,~ LIVING WAGE PROGRAM 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 ·Fax (619) 533-3240 .. ... . . . ·. ·. . w . · ,: : . _.:· ..· . "' .. G:OMPANt INf;ORMATION '_' :'.:; '.t1:r'.·/i .. · .. ·· · ". ,.,...... ·. ·, Company Name: No..fJ7fl.(e.. r:1.~.1?. . r;omp~n1q,: .. . !, .· , . , "·,"'....':.dNFO/lMA{)JONfSd.BR.ELA ·:· . . .- . COl£7P.IVN!A}t ,.. ·'..'=",;> .::.'-i"· ,., " , ., . · .· ., , · ·. P-K ._.._·:_. . _r=-'-._vv __c_.__________ 12. .o··A. __D w_o__ Company Address: ?ZO? , 1,., .L 'C'.. _t_ Direccion de'fa Com at'tfa: ::J .=:> . ~ V \ 0. Y\r.~·:·;":".: "bf::1~Y["'-C'-e:. Company Phone: ·· · · u c 1 Te/efono de la Com anra: l I +- ---1 C\ 0 C\ - b q ,_ / I 6 Supervisor Name: S ,. i.tidit(G te ;:i,·.·.:_,...:(··.... ;/~::···.: '."·i.:f?·~~:~ .· ':'.<'':·:·.: ./: ',: ·.· ..·. '.<'·}'.:'.::;':£MP~p_v~·~ lfilFO~M~T_i'qN~.~:~ '.t-. r2~~P"".. ;·;:· :."' :~ :· ·, ·:. . .· ~ . ·.; . · ., :. : . "· . ,.. ·· __ ,,,·. . ·r4NF08/l/1AC./ONS.OBRE,ELEMPL;f.AO.O..,... .,::'.- .... ; , .... . . ·. 1 Your Name· i--S._u_M_om_b_r6_.--~'·, '- .v..J 1'-U. <.,A.t l}-1 ~ Address: 'J Direccior _ . _. ____ _ Telephone number Home: Numero de telefono Residencia:· Hourly Rate Paid: l'J Sue/do or hara: \ 7 . 0 \,... 1 Social Security Number: NtJmero de Sequridad Social. l Current job title: \ <- Puesto: .S. V\.. C C C\.."T .e._ v-Do you receive health benefits? .y,c ·Recibe U.'>ted restaciones medicas? 77T J ---1 .,L--- - Signature ·Irma de/ Empleado c Date· Fecha Contract Number: s·d 1>911029 sos 3~01s ~n~a1Mo Send fohn to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236"6682 Fax (619) 533·3240 <\\t)\l \ ·~ ~·~,;;_:. ~~·:»;--: :).,."'::;:,,,,i, t Company Phone: , .. · · · Telefono de la Compaiifa: qO°\ . . .- L\ Co C1. - '51 D Work Site Address: /'. ~ n. c.. Sitio de Traba/o: G I -\ O C\' '-...'l AW V 1 IS '-l O Supervisor Name: ('"\ t S I (' , l . t rJ. te/G J/X.'·! ·: ,/ ~:>~<'. ~~ ~\; ::;;!. :>.:~ ).~'. ·-: ;~·:"'" ,:·:'. : · ·: .·/~~r;:;;2~iEi:~~~~~~~~~~~;iZ~"~~:;~~f;,p-:>?·} ·, .- :· ·-' · _;, .... >"·.::: .: .:"· :": -,~·:':.:-: . _. Social Security Number: Your Name: SuNombre: NOmAm dA Seauridad Social· Address: Direccion: Telephone number f:,"l.. { Do you-re-c-ei-ve_h_e-al-th_be_n_e_fit_s?-._f).,....,__ti_ _ _ _ _ _ , ·Recibe usted restaciones medicas? Use reverse side if needed Use el reverso si viere de mas es. 'llciO Contract Number: LWO Analyst: .P.9 '[ '[ 029 sos 3~01S ~n~ITlC'lO Send fonn to: CITY OF SAN DIEGO. EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS LIVING WAGE PROGRAM . 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 . Fax (619) 533-3240 Company Name: ., ·' .... · Nombre de la Com atifa: Company Address: Direccldn de fa Cq._m,_pa_tJ_fa_:_J'--"0~1..__~-C.,.....';_,_>.to"""n..'"""7"_,__""':'J_··,=··-;·~·,··~':-::.~··~'-·:~-";\""""~.~'-':i""~"'~~·~=·-=~'~:·"'_'- - - - - - - - - - - - - - - - - 1 Company Phone: .,..5/0 I Telefono de la Com afifa: Work Site Address: Sido de Traba 'o: .c 1·r Supervisor Name: Su I 'nt dent i/G nte .· .·.;....: .:">- ~"<::·::;' '.;;:~.::\c. ~· .. "•.'·..:""::·· (:···: /:: >i'": -·; ":_ :·..,: -:. . ·, ; :. ·: :: '. .EMP: OXEg INFOJ<~J.\ yr'o{l.{.,,(>1'?:;:~:,;,;~.~; :/ ':. ~ . . r_.-·.<·:·~·..:" · : · ... ·. .· ....'· Your Name: Su Nombre: Address: .'\ ~·:·'li, .. :., .._._c.,..,_/NFORM,ACION OfJREELEMPLE,f.iDO... _. .. ·::. ·· . .,.~. ·. :. · ..~~ " .. · Social Security Number: Numero de Seguridad Social.- '' Direcc;or. Telephone number Home: NiJmero de tetefono Residenlw: Hourly Rate Paid: 13. '2.. cJ Sue/do or hara: Current job title: Puesto: f o Tl... f.A. v fan.. M Do you receive health benefits? Recibe usted restaciones medicas? ---·---:" AJ./ ,.;• ...· . ~· ' . . .· "'· ~ . \._.J~.L:...!~~:.L:=:.=-__;:,.~~_,=--o""'--4-E...1.rt..!>..!..2C!,;..C<.Ll.i,:;Q..1..:ll'""),,..Q~~o..&.U.uu.17_.;:;,:;,,Q..M.~·-------------l I---'"'-"-'"""-'--'-'-'-=-"'-"'-'"'-..,,_ _ _ _ _ _ _ _--\,-( Y A ,.u rG ..s 1!s re A 5Lr7u fl.Aµ 2A Y ~ J- ;Jo I-' o5 f;:i r:; v A v . L 1 "', _v.j ;Oo -.z.o 11 Use reverse side If n.ooded Use el 1-everso sire ulere de mas es ac/o 7-5-11 Signatur&kl Fidna de/ Empleado L. • d trsi:i:o2s sos w /.I c 1.t.- Date· Fecha -Jt-01~ - 00([; ( 'il·f? Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM 202 C Street, MS 9A, San Diego, CA 92101 EMP.~OYEE COMPLAINT FORM FORMULARIO DE QUEJAS Phone (619) 236-6682 Fax (619) 533·3240 ;'.:(~;~_; ~:<·.:.H:-~{~.-~;,::.i.~it.~~;:;,;~~ :- {/<:_.'.:,::/·{.-:..'., :~:(i~i.J.8.i~~~~~:~::~~g;~4~;~j~;://;:;,i-~ ,;·:·;~~.k- _,. ··~ ~. . ··.f:i. _ :· ·. ·_:; Company Name: . · . ~ 0 ~res_'. I 1 P, .. C( Nombre de la ComoafJ/a: R- i; 'A j) Company Address: .. --~.- .... .·. .__ ~:-. A q11f;:::::).. " Company Phone: (_qt;,· I-JG 9- 5 16 / Telefono de la Comoanra: Work Site Address: I" ~ ,-.::}:::<~-t~.:. _-::~;' .·.,_<::«:··· :_:. --.,~MP:lf?YE'~: l~F:qRIVlA °00N_· ._ ', ·:.:.~";;.~:~:):·-~·",;-'.':·:=;:;\:: ,.~.:·- ,_, . . ;> . : ,__.::. '·-'... ,; ,_,., ,'. -:,,;:''- . ·:· ··.;.~';. · . _:··.: :..:':·: _,:. INFO.RMACIONS,OBRE Et.£NIPLEAD0i ':,~.;.,_-:· ..... j.... _- ' ·:· Your Nar-· Social Securtty Number: f\/1imJ:Jrri rfo <::,:im trirf::lrl _<:;nr.ia Su Nom.,. V' v L !<..- , _ v· r-tJ ,,,_,, L Addres · Direcci..,, ,. - t.. ""I 1.#f l f Telephone number NVmero de telefono Hourly Rate Paid: Sue/do or flora: Current job title: Puesto: Do you receive health benefits? ·Recibe µsted restaciones medicas? -. .,( . ~·~\ '•. : ,. __ as. en c '.:;._ - c - :< '. · ·-: V• ,#-. '<;...> ·1 • • ·: f.' ........ . -~-=·--~~:·. 'f~ •• ;,:,.~: ~. '" Use reverse side if needed Use el reverso sire viere de mas es. aclo Signature · Firma def Empleado Date· Fecha LWO Analyst; ________________Co~n=tra=ct.o...:N..;.c:u=-m=be=r"-:-----~ V-9110~9 sos Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS Supervisor Name: Su erintendente/Gerente: Your Name· Su Nombrc: Ad ess: Direccio, _ Telephone number Numero de teletono Hourly Rate Paid: Sue/do or hora: } Social Security Number: Numero de Se uridad Social: Home: Residenc1 i );{, 7tJ rk: Traba'o: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? ·Cuan far o le tiene traba '6 ara esta com aiiia? 11 If Yes, how much do you pay for your benefits? ·Si Sf, cuanto le hace a a or sus beneficios? if 13-JO Do you receive health benefits? ·Recibe usted beneficios medicos? Of "!!!"9"!~~~~~"""11!"! Use reverse side if needed Use el reverso sire ure de mas es acio /} J - / CITY OF SAN DIEGO Purchasing & Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 Signature · Firma de/ Empleado / o LWO Anal st: Date· Fecha Contract Number: l Send form to: EMPLOYEE COMPLAINT FORM FORMULAR/O DE QUEJAS. Company Name: Nombre de la Com aiifa: Company Address: Direcci6n de la Com an/a: : Company Phone: Te/etono de la Com afiia: Work.Site Address: Sffio de Traba o: Supervisor Name: Su erintendente/Gerente: CITY OF SAN DIEGO Purchasing & Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 . 9:212.3 5L/ 3379 Your Name: ,..., Su Nombre .._ ,.,,_,, v y 11 , v Ad ess: I n; ,,--Direccion Telephone number Home: I Numero de telefono Residench Hourly Rate Paid: Sue/do or hara: · I) 0 / '2{} Current job title: / Tftulo de Traba'o: f Do you receive hea benefits? ·Recibe usted beneficios medicos? Social Security Number: Numero de Se uridad Social: ~-r-=~~~---f-4.~~~~~~~~~~~~-'--~~-"--~~~~~~~~~~~~~--j • - . l 1 v ,,. ,,...., 7 k r?/· () vvonc Traba'o: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? ·Cu an far o le tiene traba '6 ara esta com afi/a? If Yes, how much do you pay for your benefits? ·Si Sf, cuanto le hace a a or sus beneficios? 1'!!"9'1'~~~~~~ 0 ease '--~~~~~~~~~~~~~~~~~~~~~~~~~~~- -Signature · Firma def Empleado 1 ~ Date of Receipt: LWO Analyst: .... ' Use reverse side if needed Use el reverso si requre de mas espacio Date · Fecha Contract Number: Send form to: EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS CITY OF SAN DIEGO Purchasing &Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 COMPANY INFORMATION INFORMACION SOBRE LA COMPAliiiA Company Name: Nombre de la Com aflfa: iP1 Company Address: DirecciM de la Com afiia: 322 Company Phone: Te/Mono de la Com afifa: Work.Site Address: Sitio de Traba 'o: a !1 , U1FV/ Supervisor Name: ' Su erintendente/Gerente: a a I SA l Your Name: Su Nombre: Ad ess: Direccion: Telephone number Home: , Numero de telefono Residencia: Hourly Rate Paid: . . , Sue/do or hora: 1. / l..L(I , 12. JO,. f; / 3 . 20 Current job title: : j Titu/o de Traba o: 1. I (} Do you receive healtnbenefits? ·Recibe usted beneficios medicos? !Jo - -·· ,_.. , , / '-"' .-'1.-V~T Social Security Number: Numero de Se uridad Social: f ~... - ..... r r I '../ , ,_,. (..... V]!J t -- ~ ' • I (.,)(.., f I ' I ,...-/ ' Worlc Traba'o: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? ·Guan /a,-, o le tlene traba'6 ara esta com atiia? if Yes, how much do you pay for your benefits? ·Si Sf, cuanto le hace a a or sus beneficios? q/ o3 / O 7 i /L / / a '!!'9'9'~~~~~~ D/ec1.se Use reverse side if needed Use el reverso s/ re ure de mas es acio I' /ll)A . /) ~ ,-117 Signature · Firma def Empleado LWO Anal st: 1i/ l/Date11 · Fecha Contract Number: Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 533-3948 Fax (619) 533-3220 COMPANY INFORMATION - INFORMACIONSOBRELA COMPANfA- Company Name: Nombre de la Compafifa: Company Address: Direcci6n de la Com afifa: Company Phone: Teletono de la Com afifa: Work Site Address: Sitio de Traba 'o: Supervisor Name: Superintendente/Gerente: -' · - · -- - -. - -·--- · · , - - o! C/i . Your Name: Su Nombre: Address: Direccion: Telephone number Home: Numero de teletono Residenc Hourly Rate Paid: Sue/do or hara: Current job title: Puesto: Do you receive hea benefits? 1.,Recibe usted prestaciones m8dicas? EMPLOYEE INFORMATION LNFORMACION SOBRE EL EMPLEADO Social Security Number: Numero de Seguridad Social: ,, . . . rv u ., _ ·. ,,._ / c-, , ~~--=-t----,,-:<"'---"-,(-----<'--l-J../..~~--"~:...LC---,f..LL:b>-:-1_.L~~-'-"'.....!.....L'--~~~~_!__!__,...,c_~~~~~--1 Use reverse side 1 needed Use el reverso si re uiere de mas es acio I . Signature" ·Firma def Empleado LWO Anal st: z- 2-9- 12_. Date· Fecha Contract Number: Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS _ - ~ -_ ' _- - _ · -- - _ - EMPLOYEE INFORMATION - - Your Name: Su Nombre: Address: Direccion: Telephone number ~ Ct)J Numero de teletono Residencia: Hourly Rate Paid: fl . JP/( ..ll/ Sue/do or hora: Current job title: p Puesto: e.tit ' (t L-i -, +~y--Do you receive health benefits? '1 t,Recibe usted prestaciones medicas? z ft COMPANY INFORMATION - INFORMACION SOBRE LA COMPANiA = Company Name: Nombre de la Com aiifa: Company Address: Direcci6n de la Com aflfa: Company Phone: Teletono de la Com aflfa: Work Site Address: Sitio de Traba'o: Supervisor Name: Superintendente/Gerente: -< -- 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 -_ - -~ - - INFORMACION SOBRE EL EMPLEADO. _ Social Security Number: - - - -_ - : C- - -- - ·_. - • -_ • - -' Numero de Seguridad Social: z- ,, 7 :> Work: 'raba'o: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? 511--i CL ~ ; f I ·Cuanto tiem o ha traba'ado para esta compaflfa? If Yes, how much do you pay for your benefits? t,Si Sf, cuanto le hacen pagar por SUS prestaciones medicas? ~~~~~...,..~ Use reverse side if needed Use el reverso sire uiere de mas espacio // / JI I u~nature · Firma-<.-_~----~-~--~-~----­ Work Site Address: Sitio de Trabe o: Supervisor Name; Su erintendente/Geronte: Your Name: ,,,.... , Su Nombre. Address: Direco/on: \ f ......... I . -·. "'v ' J v._. I r I Kl t. J T ..- ~ fl._r.r C::iJeJal Securlty Number: . Omero de Segur/dad Soc/a! -I-'. '-'.4 ...,,1 I '.3 < Telephone number Homa: ' Wor'itY NrJmero de te/etono Residencia.:_ abajc Hourly Rate P·aid: ./)I overtime Rate Paid: ..lc.oml'YJ 1. 4 year Agreement 2. 07/01/08 Mano.gers (Concession Stand Manager, Vending S_t~nd Manager, Pantry Manager) Assistant Managers 02/01/09 $12.40 $12.90 or $0.50 increase or $0.50 incrnl'.lse $11.40 ...... 02/01110 $13.40 $13.90 $0.50 increase or $0.50 $12.40 $12.90 Of $11.90 ,., ____ 02/01/11 inCr<;ase All classifications (including Concession Stand Worker, Vending Stand Worker, Skybox Attendant, Partybox. Attendant, Beer/Partybox Runner, Barback, Beer Tender, Cashier, Hostess, Cook/Carver, Foodline Worker, Dishwasher, Warehouse Worker, Warehouse Helper, Lead Cook, Table Runner, Inseat Runner, Pantry, Beverage Steward) excr;,pt those listed in next 2 t- $10.40 or $0.50 $10.90 $11.40 $0,50 increase or $0.50 increase Of increase $11.90 $0.50 increase Of cater:;orfos Cook/Caver Le.ad cook ........-. All Bartenders, Waitresses/Waiters/Cocktails~ In-seat Servers, Bus Perso11s/Food Prep Bartender Service Ba1tender (no contact with the publk:) Waitresses/Waiters/Cocktails In-seat Server Busperson/Food Prep All Site Attendant, Catering Attendant, Waitress/Waiter working with service charge Suite Attendants Catering Attendants Waitresses/Wafters worki~g with servic.e charge $10.74 $10.74 $0.15 increase or $10.80 - $11.24 $11.24 $0.15 "1~:·- 600~ ... $11. 74 $11.74 $0.15 increase $12.24 $12.24 $0.15 or increase or $10.80 $11.10 $11.40 $12.04 12.04 $12.34 $12.64 $8.00 $8.00 $8.24 $8.00 $8.00 $8.24 $8.30 $8.30 $8.54 $8.60 $8.60 ·No increase No inc.rease No increase No increase increase or $9.28 $9.52 $9.28 $9.28 $9.52 $9.52 ..,,...__.. ----······ ·-·' ··-· $8.00 $8.00 $8.00 3. Learner Rates: New hires - $1.00 less in first 6 calendar mo11ths -~ ~·~ $8.84 $9.28 $9.52 $8.00 .. ·- CILl-Oo \ e Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS . ·ci. ~ ~ 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION INFORMACION SOBRE LA COMPANIA Company Name: Nombre de la Comoafifa: Company Address: Direcci6n de la Compafifa: Company Phone: Te/etono de la Comoafifa: Work Site Address: .1 Sitio de Trabajo: "< Supervisor Name: Supervisor!Gerente: OI 'i Your Name: Su Nombre. ,,G l Address: / '"" ~ Direccion: Home: Telephone number Residenc1a: Numero de teletono Hourly Rate Paid: 0' Sue/do ·or hara: "ff ] , Current job title: r , Puesto: > C" t r/ r 1 Do you receive health benefits? t,Recibe usted beneficios medicos? 7 t( c I I ( I E PLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: Numero de Segura Social: I"' lr I l) O ( I~ ; t e./°' - I'"""" - 0 Work: Trabajo: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? t,Cuanto tiempo ha traba'ado para esta compafifa? 1 If Yes, how much do you pay for your benefits? t,Si Sf, cuanto le hacen pagar par sus beneficios medicos? 3 r ......-~-""-- T Tu! /. Use reverse side if needed Use el reverso si re uiere de mas es acio r;J- I ul!:J I lctlU I ti . r/11/ Id LJl;j/ Cl ll}Jlt:t8do Date of Recei t: 1)-1 _, ?D\ 6 LWO Anal st: Date· Fecha Contract Number: ' (L I LI 430'; I Send form In: CITY or SAN DIEGO LNING WAGE PROGRAM 202 Street, MS QAI San UIago, CA Phane (619) 239-6682 Fax (519) 53343240 EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS SOERE Qoa one Mo 1 a'WprIga I Numb/e deI'a Cnmnafl/a: m. I (an Diego 0,4 92523 58) 492i 5252 mood: Siam mega Supervisor Nams v. pm. M: n4 Vour Nam Su Nombre Address' - DIrsccioh. TeIaphune number Home A'UmemdeteJe/cna' Res/dew; Tram Emmi"? 5* '0-35 V0 I 88 I CuwanoblItIe Huonnghaveym.warkederscomoany? Ipuma: yam me you recewe health harem? NO II Yes. how much on you pay Ior your benefits? I RecI'bs uslsd beneficius med'Icos9 Si Si' cua'ntu ls hacsn aarpo/ w: beneficios medIcos? 1 EMPLOYEE COMPLAINT I DUEJA DEL EMPLEADU jaw/I Iiza am not wer payed fine, WW mm (OW Home T6 mplovw I I Iob SI and @9va 0% I0 gawavbd" 399W II HO me Ical Usa reverse sIce aeeded~ Use eI reverse 5, requI'ere as was sspac/o Data Fauna FOR OFFICIAL USE ONLY PARA USO OFIGIAL DE LA CIUDAD SOLAMENTE i olReCe Send form to: CITY Of SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego; CA 92101 Phpne (619) 236-6682 Fax (619) 533-3240 I COMPANY INFORMATION 1 ·iNFDRMACJ6N SOBRE LA COMPA!JfA · ~~~b~;~~~m~m~~---·~~(JT-__._, _·__· ----~-~'"·--· . . --·--------< Company Address: · . ·. . J Direcci6ndel~Compaiifa: 3cw.JU>_of f Q{?o.i.?e w Si '\ :±hiz. ~ ....... ~..~,. -~.-J:eq.~.f__:fa_..±b.J<"~~-l:Q~d~. ~...m:L._J:~c&rd1~/~--.E-htr.n1...~.. a.s.ktaol {.).J ~ w.tJ dc?J ~ e.A · -fur ~ ~ ~+t:t:tts·-~· ~ -:--~-~---'9£~--~-~. Ncf?±b_.~~~- . ~1~li!·L~ \ 0 c r.cr\-~.Q...r..A - ·- - o ....1 A._ n...- 11 ~· ~ - ,.-v,, ,.....c -~ __· 'tu-j 1s cJUfi ~ V-Qf ££ s f ~ ~ LW~ ~ ~ '"Ls~ +hl 10.i..tL\ ~ l Of UY>..Q) ~ U.-.'J2. _E. '-\-hl'"' --c: ~ ~C'ij~ . cfLv4 ~ ~ ~ "1 <> ~ c:u:J.~ l 'd. ~ ,,} t.l~ , Q \(.LJ2.t2..n £.D . Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARJO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Fax (619) 533-3240 Phone (619) 236-6682 ( . - -··0~-11v111 ...W"'::..'"'7" ______ '~ Dfrecuron: ' · · Telephone number ce,~\-loleri' Numero de tetefono Hourly Rate Paid: Sueldo or hor~: :t' · / i.t\· Res/der1'eia:' rt 'V 0 ,~ · 1 ..,\,,,I{ i_.1 1 v\.,.. Current job title: ·0ru~¥-----Puesto: Do you receive health benefits? \J.(!j; (:Rec/be usted beneflcios medicos? 1 u 1t- . ., ~· • ~' ~?\I Tra..,"' "· . •...___ Overtime Rate Paid: ,1 1/ ·-f'-"' TI4 74 use reverse -sTcie if needed Use el reverso si requiere de_~g_aciq_ Date· Fecha . V- •JI . -.. 1 yea rf t . J.:43 "" ' .,,; - .. j '-""' • • • c -C:: Sue/do !22L.b2.!:as extras: · f ·~ How long have you worked for this company? ,.:_) 'Cuanto ttempo ha trabajado para esta compafli~...., __, "·-•m·~ -~---·If Yes, how much do you pay for your benefits? ~ t,Sf Si, cuanto le hacen a ar or sus beneficlos meOicos? , ~~·~ • 'tJ nd"\f Ar- :. Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-324C • Company Name: Nombre de la Com afiia: Company Address: Direcci6n de la Com aflia: Company Phone: Teletono de la Com afiia: Work Site Address: . Sitio de Traba ·o: Supervisor Name: S . G t iJ ' EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: Numero de S uro Social: Your Name: SuNombre. Address: Oireccion · .- · ' · !J. \ Telephone 11umoer Home: ,,..,,, "-- .....,._,_, Numero de telefono Residenc1c · · Hourly Rate Paid: fh; _ Sue/do or hora: 7 0, Current job title: e i c,.o Pa.rk ti o I £.L•1 f eer Puesto: Do you receive health benefits? , / ·Recibe usted beneficios medicos? /\/{) ., >I v• I 7 ~-·-~--'---~"-'4~-,--~~~~~~~~~~~~--1 /vof)~ I p " II /1//J-013 Date· Signature · Finna def Empleado Fecha FOR OFFICIAL CITY USE ONLY PARA USO OF/CIAL DE LA CIUDAD SOLAMENTE Date of Recei t: II LWOAnal st: ~~ Contract Number: L Cl~ --tJD~ Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619} 236-6682 Fax (619) 533-3240 COMPANY INFORMATION INFORMACJON SOBRE LA COMPAN{A J.) Supervisor Name: Su ervisorGerente: D _ , Your Name: ,, Su Nombre>.._, Address: Direccil.,... ..,, ' • · " - · ~ · -Telephone 1....... uv1 Home: Numero de telefono · Residencra: Hourly Rate Paid: () Sue/do or hora: Current job title: l.CO Puesto: c. n Do you receive health benefits? ·Recibe usted beneficios medicos? 1' . v-'"' J Social Security Number: Numero de Segura Social: -'---'-~--~ p..o Use reverse side if needed Use el reverso si" uiere de mas es acio \ ' I - SignEiure · Firma de/ Empleado ___,_/.:_ _ _ ( Nu v 2 C> I 3 I Date· Fecha Contract Number: ,.,· • ~ ' I EMPLOYE.E COMPLAINT FORM FORMULARIO DE QUEJAS '·, \ •. s~~d ·r~rm.to: i . . \ CITY OF SAN DIEGO I LIVlNd WAGE PROGRAM \ 402· C Street,· Ms 9A; San Diego, CA 921' \ Phone (61.9) 236-6982 · Fax _(619) 536-3 \ '' COMPANY INFORMATION INFORMACION SOBRE LA COMPARIA . '. ·, Company N~r{1e.: . . . .,:.. . · 'r£f y' .;;. ~ e "7-' 4 Nombre de Compaflia: ..:.; 111 ~"' ' Company Address: Direcci6n defa Com afiia: Company Phone: '· Te/Mono de la Com afiia: Work Site Address: ... Sitio de Traba ·o: · PET4- CJ.· ·?A~ K Supervisor'Name: " . Su e1VisorGerente· ' EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Social Security Number: Your Name: Numero de Se llro ·social. ....... Nombre. .- ta ~ - Su .~. . - ---~·- '· \ ·:• ~~ 7 DirecciOJ . - · ·, · ··- • • .. ~, • ""'~ :;,/iN ,Y.::>tt,1;t:::.u ·~rv. 1~ • - ."> ·.· Telephon? _nu111ber Home: <: · • /I · Numero de telefoho. Residenci IV' • L ' ' LL>~ ~ rabajo: (";'A .. . Hourly Rate Paid: JI ·:. · · . , ·Overtime Rate Paid: .. ·· if /A · · · T:P#tJ!(!.& s Sue/do orhoia:·i::V €tJ · />6'1!? L>/J 'Y Sue/do orhoras extras: f /f Llefl'.5CJl'Vi . Current job title: :5eT Uf ~IJ~/M-B"NT AND 6eNS-Ml, Howlo.n,g bavey~u worked for this company?·· · tJ'l-CJt-·:uJl.3 Puesto: · €· ·' · ·cuanto tiem o ha traba'ado ara esta com afiia?ra 08- 2.Y"".2.01.!. Do you receive health benefits? , If Yes, how much do you payJor your_beriefits? .. c. , " , , .Recibe usted beneficios medicos? N;" ,. .·$i Si,-:c;.QanfoJe hap,en 'a ar orsus"'beneficios medicos? • &/7· · IA Signature · Firma def Empleado Date· Fecha FOR OFFICIAL CITY USE ONLY PARA USO Ot=ICIAL DE LA CIUDAD SOLJJ.MENTS'------------ate of Receipt: LWO Analyst: f; u Contract Number: (, l L{ -OD<.o Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone 236-6682 Fax (619) .533-3240 ,. (619) . . . :.· " COMPANY INFORMATION INFORMACION SOBRE LA COMPANIA D . · ' ·/ ·~ J ' f · ' t. I Company Name~ ·~ · 0 t L/} · · 5 /J ().r &: Nombre de la C~Panid: c" l o..r \"7/)eL~hon fl e.ru~ CompanyAddress: f'i .I ,{Al ) ·, . .v · .7/ Sa/i/0-c/ttqAf! Direcci6ndela Com afifa: T-ety Aff:/r GI CurwlL/t 9.JJ.IOf a..MY 0 Company Phone: .•.· : · · ' · l · · , Tefefono de fa Compafiia: ({) L (Q 0 £ If 5 Work Site Address: : · · 1 Sitio de Traba'o: · 00 Supervisor Name: · , __ · Su ervisorGerente· EMPLOYEE INFORMATfON lNFORMAClON SOB{?E EL EMPLEADO Social Security Number. Your Name:. ' -~ Numero de Se· uro Social: Su Nombre: Address: • , ,,.., ) ___ Direccio1 I Telephone number··~,, · Home: "'• -' ..•.\ --~ · "'--.,.. ;... · ' ;.r . 'Nork: · Numero de telefono Resid~111.;id. ~- Traba'o: f) ' UJo11/111'CT! ($' f.rut'n,EJIW!n6£LL/A /(e c q- Do you receive health benefits? ·Recibe usted beneficios medicos? . - bl,_ If Yes, how much do you pay for your benefits? ·Si Si cuanto le hacen pagar por sus beneficios medicos? EMPLOYEE COMPLAINT QUEJA DEL E[Jl}PLEADO _ Use reverse side if needed Use el reverso si re uiere de mas es acio ,~ - / YV /\ ~! \ SigfiitUffi.F[rafJet E~ · · Date ~ Fecha . .1 LWOAnal st: Contract Number: 1l ...\ - . t' "'""" i ( ! J ,. Send form to: CITY OF SAN DIEGO ' LIVING WAGE PROG.RAM · EMPLOYEE COMPLAINT FORM FORMULAR/0 DE QUEJAS ·• i' 202 C Streeti: MS ·~A, San Diego, CA 92101 · ·Phone (619) ·236-6682 ·Fax (619) 533-3240 '4.' .... "- < ·~ COMPANY INFORMATION INFORMACION SOBRE LA'COMPANiA .... .... ' '' Company' Name: ,. Nombre de la Compafiia: ~llFET Y Nt:T Company Address: Direcci6n de la Comoaflfa: co/npany Phone: ·. ·· · · ~ 1 · . .,1.r7 Te/Mono ·de la Coinoaflfa: (0/ J 60 2 - 7.., 1..J v~~rk.s.it~ Aadn~~s:·.. · 0 . f.>A !!. k. S1t10 de Traba/o: · · Supervi~or r;Jame: s '· -rG· T ' EMPLOYEE INFORM INFORMACION SOBRE EL EMPLEADO . ' · · ·· Social Secu'rity Number: Your Name: ,,_,. . Numero de.Segura Socia/.- ....,. ...,, Su Nombre: - ' Address:' / n. ~ Direccion Telepb.one number ·. "· Home: . :Jlork:. Numero de telefono Residencia: 1.1 .. -· ., v Traba10: Overtime f3.ate Paid_:. . . ;\/ PIT-PR e-s . \ Hourly Rate Pai~:. . 4! .tj?,SO PE~ l>A y· Suefdo or horas extras: · .; · · . . scrA ':$ o /../ /, J Sue/do. orhora. :tfV . .. . · • Curre'ntjobtitle: {!.A:5/11£~ /_TN¥ENT~~Y How lqng have you worked for this company? cu/~ tJ ~- 'Zb 13 . ··cuanfo tiem o~ha.traba'ado ara esta com afiia'frb ·o -2 ~zd Puesto: If Yes, how niuch do you pay for your benefits? Do you receive health benefits? M 1 IA s· S' ' t I h • • • b fi . 'di ? R 'b t d ben fi · 'd' ? r / / EMPLOYEE COMPLAINT QUEJA DEL EMPLEADO ~- 9 pc-re • ,,( • : • > .-~ l: ~ . .-. \. ·N/4 .. ·. J4 })/!> £ Signature· Firma def Empleado .w E:f!.£. ro Lb Date· Fecha Contract Number: "oVEf:: dl/·-0(){ Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com afifa: Company Address: Direcci6n de la CompafJia: Company Phone: Te/efono de la Com afifa: Work Site Address: Sitio de Traba ·a: Supervisor Name: Supervisor/Gerente: Your Name: Su Nombre: Address: n '"" .. Direccion: Home: . . . · • Telephone number Numero de te/etono Residencia: Hourly Rate Paid: Sue/do or hara: Current job title: , Puesto: \ Do you receive health benefits? tj,,.. t,Recibe usted beneficios medicos? Social Security Number: Numero de Se uro Social I "' .. "' ':::::J ' 1 /. Traba'o: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? I 0.f'f)::::fY-\-hS, t, Cuanto tiempo ha traba 'ado para esta compafifa? If Yes, how much do you pay for your benefits? t,Si Si, cuanto le hacen pagar par SUS beneficios medicos? ~:'tr.~,:;~:!'W'lrm": Use reverse side if needed Use el reverso si re uiere de mas es acio _J ~ ~- -,_ I • • A~ • \\ - a\- \?2 ~ Signature"'· Firma def Emplea'C!O"' Date · Fecha FOR OFFICIAL CITY USE ONLY PARA USO OFICIAL DE LA CIUDAD SOLAMENTE Date of Recel t: /I LWOAnal st: I! Contract Number: l/6cCooo C IL/-D{)q Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS ~~- ;-:.,>. :_. -. ~~"----. -· -' :~- .,_., ~ '- ':«._ .. ~ _-- . - ' ' . - - "' - · , ""' ·r~: ":._ ":. '-~_::>..·«- - . · ,._ Your Name: -~ Su Nombre: Address: . · 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 .CQMP~NYINFORMATION ~-:- __ . - INFORMACION SOBRE LA COMPANIA - - ·EMPLOYEE INFORMATION - · .:-_·- - : - ' INFORMACIONSOBRE ELEMPLEADO ,_- . ,, Social Security Number: de __,,,...._._ Seguro_ Social: ... -· _ _ _ _ _ _ _ _Numero ___ __ · .: -.».- '. ·_ .,_ - ~ : ·' .- : · --_ :, - --_-,,! >. ,. --". :- ,: .':" -_-,::/»."=:~,~-:-:<-: r--~- ----- Direcc1 . . _ , \ , ...., - •. -.1 v .__ - · "' ~ ~ .... , .. Telepho.1e number Home: ;p_, n , 'Nork: Numero de te!efono Resid· Tr~b: . .. ---··----'-------~---~-i 1--H-o-ur-ly_R_a-te-P-ai_d_:...--.,,..,-..-,-°I-------~ Overtime Rate Paid: Sue/do]}__or_h_or_a_:_ _ __ _ _ _ _ _ _ _ _ _ _ _s,..,..u_e_ld_...oP.or horas _extr~if:---.-,--,...,----::----......;;...-- 1 Current job title: Q · How long have you worked for this company? Puesto: ....)'Ec.'-.J~.... 1'\..,, lc~i::::. ____ &Cuantotiempohatrabafadoparaesta·compaflfa?3~~s ~r>. Do you receive health benefits? If Yes, how much do you pay for your benefits? · tRecibt: usted beneficios medicos? N'O SI Sf, cuanto le hacen a at p6tsus beneficios medicos? ... j \,/ i.-- I -'' 6 Pt: c \ Use reverse side if needed Use el reverso sf re uiere de mas es acio ~z9 .. ~Aq?' ~~Signat~ if.~del Empleado Contract Nu~~~r: C0 0 '8' icbo~ Cll/-CJlD \' l Send form to: CITY OF SAN DIEGO Purchasing & Contracting Department Living Wage Administration 1200 Third Avenue, Suite 200 San Diego, CA 92101 ,. EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS . COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA Company Name: Nombre de la Com afifa: Company Address: DirecciMde la Com ailfa: Company Phone: Te/etono de la Com ailla: Work.Site Address: Sitio de Traba o: Supervisor Name: Su erlntendente/Gerente: ). ~ Your Name:. Su Nombr Ad ess: Direccion Telephone number Home Numero de te/etono Residencia: ' Hourly Rate Paid: \~ClC\ Sue/do or hora: Current job title: Tftulo de Traba'o: Do you receive health benefits? ·Recibe usted beneficios medicos?~\ Social Security Number: Numero de Seguridad Social Work: Use reverse side 'if needed Use el reverso sf re ure de mas es acio .\ Signature · Firma def Emp/eado LWO Anal st: Date · Fecha Contract Number: -#Cts ~tJD l Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION INFORMAC/ON SOBRE LA COMPANiA Company Name: Nombre de la Com anfa: Company Address: Direcci6n de la Companfa: Company Phone: Telefono de la Com af7fa: Work Site Address: Sitio de Traba o: Supervisor Name: Supervisor/Gerente: o~l Your Name: Su Nombn: __,_,,, , , ' lV'-'V · P 1 tC:'i-Address: Direcclon .. Telephone number Flo me: l -· Numero de teletono Residencia: Hourly Rate Paid: Sue/do or hara: Current job title: ca , Puesto: 0 U- '{ \{\.SOY' Do you receive health b nefits? t,Recibe usted beneficios medicos? N0 . u 11 "}r~A::::- (,<.}{)µ_µ._ j?(.!_ST"' c:_t i +~ <;;;;:. e,.,-g I R,;o EMPLOYEE INFORMATION INFORMACION SOBRE EL EMPLEADO Security Number: 1 "" ....... " Numero de Se uro Social: J - Work: ~prf/'?-?pr Traba'o: Overtime Rate Paid: /)CJ 7 '/f-t Sue/do or horas extras: How long have you worked for this company? tSt v:x_"Q~S ·Cuanto tiempo ha traba 'ado ara esta companfa? If Yes, how much do you pay for your benefits? N'J~ t,Si Sf, cuanto le hacen pagar por SUS beneficios medicos? EMPLOYEE COMPLAINT QUEJA DEL EMPLEADO :o CC).. ~/h-1Pr1f' ;(e_ __.,, ~ -:r~ 9p/:J...H 7e~ I~ A- t< ~ - . ~ -e-- °'IL ' Ac_fi "''c, .lk::?6<>d ' .Is;. 1-1nc.-c. O"- ~C'i/$C I ~Id~n. LI~ au-~Lc.tri f:L--e Ah T P"1;.D A Use reverse side if needed Use el reverso si re u/ere de mas es acio )- ..... __ :;/ Empleado Date of Recei t: RECEIVED NOV 14 2014 LWO Anal st: Date· Fecha Contract Number: ~ 6 # ~\S-60Z Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION INFORMAC/ON SOBRE LA COMPANiA Company Name: Nombre de la Com aflfa: Company Address: Direcci6n de la Com aflla: Company Phone: Teletono de la Com Work Site Address: Sitio de Traba'o: Securitas Security Services USA 1550 Hotel Circle North #440 San Diego, CA 92108 (619) 641 0049 aflia: a IOna IS rl LI !On Your Name: Su Nombre: ' Address: Direccion: Telephone number Home: Numero de telefono Residencia: · Hourly Rate Paid: $13.00/hr. Sue/do or hora: Current job title: Patrol Driver Puesto: Do you receive health benefits? tRecibe ustedbeneficios medicos? No nve Social Security Number: Numero de S uro Social: traba o: ' Overtime Rate Paid: $1 9 50 Sue/do or horas extras: · How long have you worked for this company? B · Cuanto tiem o ha traba ·ado ara esta com afifa? yea rs If Yes, how much do you pay for your benefits? NIA ·Si Sf, cuanto le hacen pagar or sus beneficios medicos? 6/6/2005 by 0-19386 N.S.) "Purpose and Intent," as well as §22.4215 "Exemptions (d);" lead me to believe it does. Use reverse side if needed Use el reverso sire uiere de mas es acio January 1, 2015 Signature · Firma de/ Empleado LWOAnal st: Date· Fecha Contract Number: Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION JNFORMACION SOBRE LA COMPANiA Your Narri1=>· Su Nomb .. Address: Direccior Telephone number ~ Numero de te/etono Hourly Rate Paid: Sue/do or hora: Current job title: Puesto: / i6 Do you receive health benefits? 1,Recibe usted beneficios medicos? Social Security Number: Numero de Se uro Socii > • ._ • l HCS/_ f - ·" ork: Traba'o: Overtime Rate Paid: Sue/do or horas extras: How long have you worked for this company? 1, Cuanto tiempo ha traba'ado para esta companfa? If Yes, how much do you pay for your benefits? !, Si Sf, cuanto le hacen pagar por SUS beneficios medicos? ~~~~!'l"IT:'...,.,~ Use reverse side if needed Use el reverso si re uiere de mas es acio I / J Signature · Firma def Empleado LWO Anal st: Date· Fecha Contract Number: \.{ bOOODlbD2 Send form to: CITY OF SAN DIEGO LIVING WAGE PROGRAM EMPLOYEE COMPLAINT FORM FORMULARIO DE QUEJAS . 202 C Street, MS 9A, San Diego, CA 92101 Phone (619) 236-6682 Fax (619) 533-3240 COMPANY INFORMATION INFORMACION SOBRE LA COMPANiA /e Company Name: '..L , , NombredefaComf)afifa: ';) C.Vf• rtlf >e?IJ/'1'-IY 5et4p,~e; v>A, .:r.11t, Company Address: re , . 1J 11 ·\ I 1 Direcci6ndetacompafifa:l1,o ().,el ~1l'&Je /v'tJNA fl/,-.,.e..., ,,.,b 5flnl>i'e9P; ~A. tJ'3 Company Phone: /' a / LJ 11 n Teletono de la Compafifa: J!'J / -, - It' "1 /- ()0 '1 7 Work Site Address: '/ t:I u a ~ Sitio de Trabaio: ~ -, '1 I t: '!f' 7 94../.e Met JI ~ q~- D> eg ~ J ~ ,q. -el-IJ.. -I - - - - - - - - - < Supervisor Name: ) SupetvisorGerente: ~ .-. • ..... - - ""· ·--.... ~··· ... -.,,-.JT;;.• "'P'"- , ___ · · · · EMPLOYEE INFORMATION JNFORMACION SOBRE EL EMPLEADO Your Name: Social Security Number: Su Nombre: Numero de Segura Social: ,.- -- • Address: Direccion: Home: Telephone number ., Work: -A .-,.... Residi;,, ,..,,a. ~ · · " ' - / Trabaio: .i Numero de tefefono --------< Overtime Rate Paid: Hourly Rate Paid: Jr J JJ ., Sue/do par hora: .11 · . ., • Sue/do f)or horas extras: How long have you worked for this company? / ' Current job title: /' ,.., •.Mt' y ,,,,,. . Puesto: :::> ~ C vn-J <..::i vq I'd ;, Cuanto tiem1Jo ha traba}ado para esta compafifa? . IJ Ye41'f Do you receive health benefits? If Yes, how much do you pay for your benefits? ;,Recibe usted beneficios medicos? . ;, Si Sf, cuanto le hacen pagar por SUS beneficios medicos? EMPLOYEE COMPLAINT QUEJA DEL EMPLEADO ff '/J. ...-J • I& • , q ... - ....... - -- *".. . ..... _ '7 ' ·W4) Pa 11c:l J.f tJ J-/pt11) Pa'l~-.Jvb . , Wt.:1 ;r1..,. c.: t{P IJ r'41 ., JfJl. · "~ / J 4 >lovts t{ ).. L/ / ( 1r1.';~;,,9 JJ, He>vl's) J-/tJl/~J Vt::tt::4..J,'011 , , ol MY F~ll pqy 1'Vtu1'J mYve:u::.4--/-1011 A~p~-#-_. ~ .:i1gnature · Firma def Empleado ~--· . - . Use reverse side if needed Useelreversosireauieredemases1Jacio ' f eb JJ:>J ().OJ~ Date· Fecha