BUCS Comprehensive 2023-24

District or School Entity Name:*

Contact Person - First and Last Name*

The person that should be contacted with questions regarding this form.

Title*

Email*

Phone*

Total Number of Employees with wages more than $10,000:*

Tax Collectors are not eligible for Unemployment Compensation and should not be included in above numbers

Total Number of Employees with wages less than $10,000:*

Tax Collectors are not eligible for Unemployment Compensation and should not be included in above numbers

Total Wages Paid to Employees with less than $10,000:* $

Tax Collectors are not eligible for Unemployment Compensation and should not be included in above numbers

Please upload documentation for above figures*

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Please combine documents into one PDF document

Please Note: If you use the CSIU Payroll System, there are two reports set up that will provide the information needed:

Unemployment Comp/File (this is a detailed report, last page showing totals, must be run by quarter) report tag pyucqtr - you need to select print reports only. Return a copy of the last page showing totals for each quarter in 2022 and list the number of total employees for each quarter.
Unemployment Comp/PSBA report tag pyucpsba. Attach a copy of this report. This shows the $10,000 cap payroll as well as employee count.

Please upload copies of the 941 Federal Wage Summary Pages for all 4 Quarters of the previous year*

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2022 Calendar Year

Please upload any additional documents as needed

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Do you anticipate any restructuring or reduction of revenue sources resulting in layoffs in the upcoming school year?

Yes No

Please explain:

Have you experienced any staff reductions, other than regular seasonal, in the last 36 months?

Yes No

Please explain:

Please include number of affected employees and the dates on which layoffs or reductions took place.

What services do you currently outsource?

Bus Drivers Substitutes Food Services Maintenance/Custodial

Other:

What services do you anticipate outsourcing in the upcoming school year?

Bus Drivers Substitutes Food Services Maintenance/Custodial

Other:

Terms and Conditions - The information provided on this application form has been confirmed by all necessary parties within this organization to be true, accurate and complete to the best of our knowledge. We acknowledge that any misrepresentation will result in immediate cancellation of service.*

Agree

Signature*

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