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Fillable New York 112 Form in PDF

The New York 112 form is a crucial document that ensures compliance with prevailing wage laws for employees working on construction projects managed by the New York City Department of Parks & Recreation. This form not only outlines the employee's rights regarding wage and benefits but also serves as a formal acknowledgment of the prevailing wage schedule. Understanding this form is essential for both employees and employers to uphold labor law standards and protect workers' rights.

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Article Guide

The New York City Form 112 is an essential document designed to ensure compliance with labor laws regarding prevailing wages for employees working on city-funded construction projects. This form serves multiple purposes, primarily confirming that workers have received and understood the prevailing wage schedule as outlined in New York State Labor Law, specifically Section 220. It requires employees to provide personal information, including their name, social security number, and address, alongside details about the specific project they are involved in, such as the project name and contract number. Importantly, the form highlights the employee's trade classification and the corresponding wage and supplemental benefits they are entitled to receive. Should an employer fail to meet these wage requirements, the form empowers employees to take action by filing complaints with both the NYC Department of Parks & Recreation and the New York City Office of the Comptroller. The document concludes with spaces for signatures from both the employee and employer, as well as notary verification, underscoring its legal significance and the commitment to uphold fair labor practices within the city’s construction industry.

Preview - New York 112 Form

City of New York	Form 112
	Form 112
Parks & Recreation

N.Y.C Department of Parks & Recreation

Labor Law Compliance

EMPLOYEE PREVAILING WAGE REQUIREMENT

1). I, _________________________, social security number _____________ residing at

_______________________________________have received and read the Prevailing Wage Schedule

NYS Labor Law, Section 220 presented to me by my employer ____________________.

2). I am currently performing work on a NYC Department of Parks & Recreation construction project known as ___________________________________________________, Contract No:_____________,

Registration No: ___________________ in the borough of _______________.

3). I am aware that my trade classification, __________________________, entitles me to the prevailing

Wage of $____ per hour and the supplemental benefit of $____ per hour.

4). I am also aware that if for any reason my employer fails to pay me the applicable wage rate and/or Supplemental benefit rate for my trade, it is my right to file a complaint with the NYC Department of Parks & Recreation; and file a complaint with the New York City-Office of the Comptroller against my employer.

__________________________________	_____________________________
(Employee’s Signature & Date)	Print Company’s name
__________________________________	By:__________________________
(Print Employee’s Name)	(Employer Signature & Date)
	Title:__________________________
	___________________________________
	(Employer Printed Name)
Sworn to me on this ____day of	Sworn to me on this ____day of
______________, 2010	______________, 2010
________________________	_______________________
Notary Public	Notary Public


Submit Form To: Borough Director, Resident Engineer	Revised 03/2010

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Form Characteristics

Fact Name	Description
Form Purpose	The New York 112 form is designed to ensure compliance with prevailing wage requirements for employees working on NYC Department of Parks & Recreation construction projects.
Governing Law	This form is governed by New York State Labor Law, specifically Section 220, which outlines the prevailing wage standards for public work projects.
Employee Information	Employees must provide their name, social security number, and address on the form to validate their identity and eligibility for prevailing wages.
Project Details	The form requires employees to specify the construction project they are working on, including the project name, contract number, and borough of work.
Trade Classification	Employees must indicate their trade classification, which determines the applicable prevailing wage and supplemental benefits they are entitled to receive.
Wage Information	The form includes sections where employees can confirm the prevailing wage rate and supplemental benefit amount they should receive for their work.
Complaint Rights	Employees have the right to file a complaint with the NYC Department of Parks & Recreation or the New York City-Office of the Comptroller if they are not paid the required wage rates.
Signatures Required	Both the employee and employer must sign the form, along with the date, to confirm that the information provided is accurate and that both parties understand their rights and responsibilities.
Notary Requirement	The form must be notarized, confirming the authenticity of the signatures and the date on which the document was executed.

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