Connecticut Department of Labor, Partner of the American Job Center Network
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Standard Wage Rate Determination For Certain Service Workers

You may submit this form via e-mail by filling out the information below and clicking on the "Submit Request" button at the bottom of the page.

(Use the Tab key to move forward a field and Shift-Tab to move back a field)

ESTIMATED DURATION OF THE PROJECT:

Start Date 
       End Date 

STATE AGENT:

CONTRACT NAME AND NUMBER (IF APPLICABLE):

LOCATION OF WORK BEING PERFORMED:

CONTRACT DESCRIPTION:

TOTAL COST OF CONTRACT:

DATE ADVERTISED TO BID:

MAIL OR PICK-UP
 

As required by law please submit requests for rates at least ten (10) days prior to the date of advertisement for bid.

PERSON REQUESTING RATES:
 
Name:
Street Address:
City:
State: Zip Code: 
Telephone Number:
E-Mail Address:





200 Folly Brook Boulevard, Wethersfield, CT 06109 / Phone: 860-263-6000

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