Official Federal Forms > Federal Communications Commission (FCC)
Common Carrier Annual Employment Report 395 - Official Federal Forms
| Common Carrier Annual Employment Report Form. This is a national form and can be used in Federal Communications Commission (FCC) . |
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FCC 395 FE DERAL COMMUNICAT IONS COMMISSION Approved by OMB 3060-0076 Washington, DC 20554 Expires: 02/28/06 Est. time per response: 1 hour COMMON CARRIER ANNUAL EMPLOYMENT RE PORT [Please read instructions before completing and for Notice regarding public burden.] SECTION I General Information 1. Name and Mailing Address of Respondent Check here if this is a change of address. 2. Year Report Filed 3. Reporting Period (Ending Date of Pay 4. Number of Full-Time Employees during Selected Period Covered by Report) Reporting Period (check one): a. Fe w e r than 16 (complete Sections I, V, and VI only) b. 16 or m ore (complete all sections) SECTION II Full-Time Employees. Consider as full-time employees all t hose working 30 hours or more per week. ALL EMPLOYEES MALE FEMALE MINORITY-GROUP EMPLOYEES MINORITY-GROUP EMPLOYEES White, White, JOB Black, not of Black, not of Asian or Asian or CATEGORY TOTAL MALE FEMALE not of Native Hispanic not of Native Hispanic Pacific Hispanic Pacific Hispanic Hispanic American Origin Hispanic American Origin Islander Islander Origin Origin Officials and Managers Professionals Technicians Sales Office and Clerical Craft Workers (skilled) Operatives (semiskilled) Laborers (unskilled) Service Workers T O T A L Previous Years Total (if any) FCC 395 FEBRUARY 2003 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 SECTION III Part-Time Employees ALL EMPLOYEES MALE FEMALE MINORITY-GROUP EMPLOYEES MINORITY-GROUP EMPLOYEES White, White, JOB Black, Black, Asian or not of Asian or not of CATEGORY TOTAL MALE FEMALE not of Native Hispanic not of Native Hispanic Pacific Hispanic Pacific Hispanic Hispanic American Hispanic American Origin Origin Islander Islander Origin Origin Officials and Managers Professionals Technicians Sales Office and Clerical Craft Workers (skilled) Operatives (semiskilled) Laborers (unskilled) Service Workers T O T A L Previous Years Total (if any) SECTION IV On-the-Job Trainees. Report only employees enrolled in formal on-the-job training programs. The data below shall be also included in the figures for the appropriate occupational categories in Sections II and III. ALL EMPLOYEES MALE FEMALE MINORITY-GROUP EMPLOYEES MINORITY-GROUP EMPLOYEES White, White, JOB Black, Black, not of not of Asian or Asian or CATEGORY TOTAL MALE FEMALE not of Native not of Native Pacific Hispanic Hispanic Pacific Hispanic Hispanic Hispanic American Origin Hispanic American Origin Islander Islander Origin Origin White Collar Production SECTION V Report of Discrimination Complaints Pursuant to 47 CFR 21.307, 22.321, and 23.55 This is to advise the Commission that no complaints regarding violations of the equal employment provisions of Federal, state, territorial, or local statutes have been filed against this company before any bod y having competent jurisdiction in such matters during the calendar year covered by this report. This is to advise the Commission that the following complaints alleging violations of the provisions of any equal employment opportunity statute have been filed against this company. (Att ach a list indicating parties involved, date filed, courts or agencies before which the matter has been heard, file number or other designation, and current status or disposition.) SECTION VI Certification I certify that to the best of my knowledge, information and belief, all statements contained in this report are true and correc t. Date Typed or Printed Name of Person Signing Signature Telephone No. Title of Person Signing WILLFULLY FALSE STATEMENTS MA DE ON THIS FORM ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (18 U.S.C. 1001) AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (47 U.S.C. 312 (A)(1)) AND/OR FORFEITURE (47 U.S.C. 503). FFCCCC 339955 FFEEBBRRUUAARRYY 22000033 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3FCC 395 INSTRUCTIONS Approved by OMB FEBRUARY 2003 3060-0076 Expires: 02/28/06 Est. time per response: 1 hour INSTRUCTIONS FOR COMPLETION OF FCC FORM 395 COMMON CARRIER ANNUAL EMPLOYMENT REPORT A. Who Must File : The FCC Form 395, Common Carrier F. Race/Ethnic Categories Annual Employment Report, is to be filed by all licensees and permittees of common carrier stations with sixteen (16) or 1. Black, not of Hispanic origin: A person descended from more full-time employees, as required by 47 CFR 1.815 (see any of the black racial groups of Africa. item D, below). 2. Hispanic: A person of Mexican, Puerto Rican, Cuban, B. Number of Copies to File : Respondents must submit Central or South American, or ot her Spanish culture or origin, one (1) copy of each FCC Form 395 to the FEDERAL regardless of race. COMMUNICATIONS COMMISSION, Wireline Competition Bureau, Industry Analysis and Technology Division, 3. Asian or Pacific Islander: A person descended from any Washington, DC 20554 , or it may be submitted by facsimile of the original peoples of the Far East, Southeast Asia, the to (202) 418-0520 . The completed report must be filed by Indian subcontinent, or the Pacific islands. This area in- May 31 of each year. cludes Hawaii and such countries as China, Japan, Korea, Vietnam, Indonesia, and the Philippines. C. Reporting Period (item 3 of FCC Form 395): The em- ployment data being filed must reflect the employment 4. Native American: A person descended from any of the figures from any one payroll period in January, February, or original peoples of North America, and who maintains cultural March. The same payroll period should be used in each identification through tribal affiliation and/or community years report. recognition. D. Number of Full-Time Employees (item 4 of FCC Form 5. White, not of Hispanic origin: A person descended from 395): (1) If the filing concerns a reporting unit that had fewer any of the original peoples of Europe, North Africa, or the than sixteen (16) full-time employees during the selected Middle East. payroll period (see item C, above), no Form 395 filing is required. Such a reporting unit, however, may fill in Sections G. Job Categories I, V, and VI of the form and submit it to comply with the respondents reporting obligations under 47 CFR 21.307, The following job category definitions are provided for your 22.321, or 23.55. guidance and may be used in completing FCC Form 395. A person who works in more than one job category is to be (2) If the filing oncercns a reporting unit that had 16 or included in the one that repres ents the most impo
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