NCS 12-3G Work Level Form

U.S. Department of Labor WORK LEVEL FORM (Government)

Bureau of Labor Statistics National Compensation Survey

The BLS publishes statistical tabulations from this survey that may reveal the information reported by individual State and local governments. Upon your request, however, the BLS will hold the information provided on this survey form in confidence.	This report is authorized by law, 29 U.S.C. 2. Your voluntary cooperation is needed to make the results of this survey comprehensive, accurate and timely.	O.M.B. # 1220-0164 Expires 4/30/15
We estimate that it will take an average of 25 minutes to complete this form, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect of this survey; including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working Conditions (1220-0164), 2 Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond to the collection of information unless it displays a currently valid OMB control number.

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

NCS Form 12-3G (September 2012)

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:

Quote:

Occupation:

Establishment Grade:

SOC:

Establishment Rate Range:

Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTRACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY – Base Leveling Supervisor

Schedule Number:

Supervisor

1^st 2^nd 3^rd Line Supervisor/Manager

Quote:

Occupation:

Establishment Grade:

SOC:

	Establishment Rate Range:	Establishment Job Title:

Highest Level Non-Supervisory Subordinate Position _________________________________________________

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY – Leveling on Duties and Responsibilities of Supervisor

Schedule Number:

Supervisor

1^st 2^nd 3^rd Line Supervisor/Manager

Quote:

Occupation:

Establishment Grade:

SOC:

	Establishment Rate Range:	Establishment Job Title:

Factor	Level	Education, experience, other comments
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

U.S. Department of Labor Bureau of Labor Statistics

National Compensation Survey Leveling Form

NATIONAL COMPENSATION SURVEY – Leveling Summary

Schedule Number:

Leveling Factors	QUOTE 1	QUOTE 2	QUOTE 3	QUOTE 4	QUOTE 5	QUOTE 6	QUOTE 7	QUOTE 8
KNOWLEDGE
JOB CONTROLS AND COMPLEXITY
CONTACTS
PHYSICAL ENVIRONMENT

Remarks

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