Illinois Certified Transcript of PayrollIllinois Certified Transcript of Payroll
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Certified Transcript of Payroll

State of Illinois
Illinois Department of Labor

Print Form

Please Note: The submission of falsified payroll records is a criminal offense.

IDOL Case File Number:

Contractor and/or Subcontractor

Payroll Date:

(Company Name)

Public Body Information

(Contact Name)

(Public Body Name)

(Contact Name)

(Contract Number)
(City)

(Street Address)

(City)

(Street Address)

(Project Number)
(State)
(Project Location)

(Zipcode)

(Telephone Number)

(State)

(Zipcode)

(Telephone Number)

Report Hours for Each Day, Including Overtime Hours, List Hourly Prevailing Wage Rate and Hourly Fringe Benefits Allotments.

Worker Name, Address
SSN & Telephone Number

SUN

MON

* Hours worked each day
TUE
WED
THR

FRI

SAT

Total Hrs Each
PW and Reg.

Total OT
Hours

Hourly Wage OT Wage
Rate
Rate

PW
N
Labor Classification
Hourly Fringe Benefit:

Pension:

Health/Welfare:

Vacation:

Training:

Pension:

Health/Welfare:

Vacation:

Training:

Pension:

Health/Welfare