Pay Equity Data Entry Form

Current Information
Pay Equity Data
Complete

Company Name

Mailing Address

Mailing Address Line 2

City/Town

State/Province

ZIP/Postal Code

Phone

E-mail Address

FEIN

Reporting Calendar Year

Any Additional Information

Do you as an employer set wages for any employee based upon

A seniority system

A system that measures earnings by quantity or quality of production

None of the above

* Length of Service on Entry Form should represent the employees' time with the employer. However, it is acceptable to instead use the length of time employees have been in their present job title. Please specify which measure of service is being utilized:

Total Time with Employer

Length of Time in Present Title