CR-1409 (11/11)								
NEW JERSEY DEPARTMENT OF TRANSPORTATION
DIVISION OF CIVIL RIGHT / AFFIRMATIVE ACTION
CONTRACTOR’S 1409 QUARTERLY TRAINING REPORT	
1st Quarter	Due Date	2nd Quarter	Due Date	3rd Quarter	Due Date	4th Quarter	Due Date	
January 1
to March 30	April 10	April 1 to 
June 30	July 10	July 1 to September 30	October 10	October 1 to December 31	January 10	
1.	Project:	     	Federal Project Number:	     	
2.	Contractor:	     	Subcontractor:	     	
3. 	Trainee Name:	     	
4.	Trainee Address:	     	
5.	Social Security # (last 4 digits)	     				
6.	Employee Status	  New Hire		  Upgrade				
7.	Ethnic Group	  Black	  Hispanic	  Asian / Pacific Islander	
		  Native American (Indian) / Alaskan Native	  Cuacasian / Portugese	
8.	Sex	  Male	  Female		
9.	Current Training Program	     	
10.	Type of Training	  Apprenticeship	  Laborer	  Clerical	
11.	Training Start Date:	     		Last Training Date:	     	
	
Hours of Training Data	January to March
2___	April to June
2___	July to September
2___	October to December
2___	
12.  Given this Quarter	     	     	     	     	
13.  Given to Date	     	     	     	     	
14.  Needed to Complete	     	     	     	     	
15. Training Progress:	Active	 Laid Off	 Transferred	 Quit	
	 Terminated	 Other	 No More Work	 Completed	
16.  Trainee Signature:			Date		
17. Contractor Signature:			Date		
18.  RE Signature:			Date		

NOTE:  ATTACH COPIES OF LAST BIWEEKLY/TRAINING CERT. TO FINAL 1409.