Illinois Department of Employment Security 33 South State Street, Chicago, Illinois 60603 www.ides.state.il.us PLEASE TYPE OR PRINT NAME AND ADDRESS OF PERSON REQUESTING WAGE: A REQUEST FOR PREVAILING WAGE STATEMENT YOUR REQUEST MAY BE MAILED OR FAXED TO US. OUR FAX NUMBER: FAX NO: PHONE NO: (312) 793-5151 REPLY REQUESTED BY: FAX PLEASE DO NOT SUBMIT DUPLICATE REQUESTS. ALLOW 14 WORKING DAYS FOR PROCESSING MAIL Employer Name Job Location: CITY, COUNTY, STATE (all required) PLEASE PROVIDE ALL INFORMATION REQUESTED NATURE OF EMPLOYER'S Job Title BUSINESS _________________________ Total Hours Per Week a. Basic b. Overtime Work Schedule (Hourly) a.m. p.m. Job Title of Worker's Immediate Supervisor: DESCRIBE FULLY THE JOB TO BE PERFORMED: SUGGESTED DOT This rate is valid for: per per hour SUGGESTED OES/SOC STATE IN DETAIL THE MINIMUM EDUCATION, TRAINING Grade High College EDUCATION (Enter number of years) No. Yrs. No. Mos. TRAINING Job Offered Related EXPERIOccupation ENCE Yrs. Mos. Yrs. Mos. O Rate of Pay a. Basic b. Overtime $ $ & EXPERIENCE REQUIRED College Degree Required OTHER SPECIAL REQUIREMENTS: Major Field of Study Type of Training Related Occupation (specify) NUMBER OF OTHER EMPLOYEES TO BE SUPERVISED (if any): R date issued thru 6/30/2009 90 days from the date of this determination. The prevailing wage for the above occupation in the area indicated IS: $ PER DATE S.O.C. Title OES/SOC Code (Rev. 07/08) IDES Prevailing Wage Specialist Wage Source: OES Other ___________________ Level ________________ (312) 793-3216 American LegalNet, Inc. www.FormsWorkflow.com