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DEPAR1MEN1 OF EMPLOYEE RELATIONS <br />3rd FLOOR SPACE CEN1ER BUILDING <br />444 LAFAYETTE ROAD <br />ST. PAUL, MN 55101 <br />(612) 296 -2796 <br />LOCAL GOVERNMENT PAY EQUITY REPORTING FORM <br />PART A- IDENTIFYING INFORMATION <br />WORKSHEET <br />Name <br />.iOSepA C614.6a�'cK <br />C�ertK rz�rlw2 <br />Work Phone Number <br />(cdi2) NcH_tI1'1 <br />Jurisdiction <br />C.1 e- c. L.,17/ <br />- CA <br />AA- <br />Streetc�-� <br />J I5" 4rale i)Ar0 <br />rf l(6R�.� <br />City <br />L'Jr/ <br />CA-ry AA A- <br />State <br />11') AD <br />Zip <br />Ss//7 <br />Type of Jurisdiction <br />Ell City <br />[� County <br />D <br />D <br />Township <br />Other <br />(Specify) <br />C] School District <br />PART B- DESCRIPTION OF JOB EVALUATION USED <br />1. What system did you use? Check all that apply. <br />D State Job Match D System of another employer (specify) <br />D Designed own fl Consultant's system (specify) <br />Co <br />')C..c \S\o.3 rt1tND ("6171- J <br />D Other (specify) <br />2. Please attach a brief (not more than 2 pages) narrative description of <br />your system, including a list of factors and subfactors used. <br />3. Information used to evaluate jobs. Check all that apply. <br />D Class Specifications ® Position Descriptions <br />i Employee Questionnaire D Supervisor Questionnaire <br />Ea Employee Interview D Supervisor Interview <br />E] Other (specify) <br />4. List below any classes that were excluded from your study, and briefly <br />explain why they were excluded. <br />PE- 00211 -01 (9/84) <br />Page 3 <br />P. 1 of 3 <br />