Bilingual Pay Authorization Form - State Of California Page 2
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2STATE OF CALIFORNIA
BILINGUAL PAY AUTHORIZATION
STD. 897 (REV. 4/95) Page 2
15.A. EMPLOYEE DUTIES (Provide a brief description of employee's duties pertaining to bilingual skills.)
B. WHAT PERCENT OF EMPLOYEE'S WORK TIME IS SPENT USING BILINGUAL SKILLS
%
16.A. GIVE A BRIEF DESCRIPTION OF THE PROGRAM OR OFFICE IN WHICH THIS EMPLOYEE WORKS
C. TOTAL NUMBER OF CLIENTS SERVED BY YOUR OFFICE
B. NUMBER OF CLIENTS USING THE LANGUAGE OF THIS EMPLOYEE WHO ARE SERVED BY
YOUR OFFICE
PER
(WK, MO. YR)
PER
(WK, MO. YR)
D. NUMBER OF CLIENTS USING THE LANGUAGE OF THIS EMPLOYEE WHO ARE SERVED BY
E. TOTAL NUMBER OF CLIENTS SERVED BY THIS EMPLOYEE
THIS EMPLOYEE
PER
(WK, MO. YR)
PER
(WK, MO. YR)
G. TOTAL NUMBER OF EMPLOYEES IN
H. TOTAL NUMBER OF EMPLOYEES IN THIS OFFICE USING SAME
F.
WHAT IS THE TOTAL POPULATION OF PERSONS IN THE
THIS OFFICE
BILINGUAL LANGUAGE SKILL AND RECEIVING BILINGUAL PAY
GEOGRAPHIC AREA USING LANGUAGE OF THIS EMPLOYEE
I. DESCRIBE THE METHOD USED TO DETERMINE THE PERCENTAGE REPORTED IN ITEM 15.B.
J. ATTACH AN ORGANIZATION CHART IDENTIFYING INCUMBENTS WHO ARE:
1. USING BILINGUAL SKILLS AND ARE RECEIVING BILINGUAL PAY'
2. USING BILINGUAL SKILLS AVERAGING LESS THAN 10% OF THEIR WORK TIME AND ARE NOT RECEIVING BILINGUAL PAY; AND
3. ALL OTHER PERSONS WHO WORK IN THE OFFICE IN WHICH THIS PERSON IS EMPLOYED.
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