Application for Employment


APPLICATION FOR EMPLOYMENT

 

EQUAL EMPLOYMENT OPPORTUNITY – It is our policy to seek and employ the best qualified personnel in all of our facilities and to provide equal opportunity for the advancement of employees and to administer all of our personnel policies in a manner that will not discriminate against any person because of race, color, religion, age, sex, marital or veteran status, national origin, ancestry, disability (physical or mental handicap), or any other legally protected status.

 

This complete application is only for job seekers who have already been approved for employment with AAA Staffing. If you have not yet been approved, please fill out the initial application.

 

LAST NAME

FIRST NAME

MIDDLE INITIAL

DATE

STREET ADDRESS

APT. NO.

CITY

STATE

ZIP CODE

PHONE

EMAIL ADDRESS

 

EMERGENCY CONTACT:
LAST NAME

FIRST NAME

PHONE

RELATION

 

PLEASE CHECK EACH POSITION FOR WHICH YOU HAVE VERIFIABLE ON-SITE APARTMENT COMMUNITY EXPERIENCE:

PROPERTY SUPERVISOR
EPA CERTIFIED MAINTENANCE
PROPERTY MANAGER
GENERAL MAINTENANCE/TICKER RUNNER
ASSISTANT PROPERTY MANAGER
MAKE READY/PUNCH OUT
LEASING SPECIALIST
PORTER
RECEPTIONIST
HOUSEKEEPER
OTHER

 

HOW DID YOU HEAR ABOUT AAA STAFFING’S SERVICES?

DO YOU HAVE ANY PHYSICAL RESTRICTIONS THAT WOULD LIMIT YOUR ABILITY TO PERFORM ANY OF THE DUTIES ASSOCIATED WITH THE POSITION YOU ARE APPLYING FOR? IF YES, PLEASE EXPLAIN:

PLEASE USE THE SPACE BELOW TO LIST ANY ADDITIONAL TRADE SKILLS, CERTIFICATIONS, TOLLS, ETC. WHICH MIGHT BE USEFUL IN DETERMINING JOB ASSIGNMENTS FOR YOU THAT ARE NOT NOTED ON YOUR RESUME:

 

EMPLOYMENT AUTHORIZATION

This authorization entitles the bearer (or sender), or any representative thereof, to contact my present and past employer(s) for the purpose of confirming my length of employment, wages and other relevant employment data.

AAA STAFFING
25722 Kingsland Blvd Suite 103
Katy, TX 77494
1-877-866-0830 Toll Free
1-877-464-1866 Toll Free Fax

 

AAA STAFFING
TEMPORARY EMPLOYEE’S POLICIES AND PROCEDURES
ACKNOWLEDGMENT

 

I. I have been informed and do fully understand that my actions during employment shall be in accordance with the following policies/procedures and other company rules and regulations and any amendments thereto. The company shall have the right to amend, modify or revoke its rules at any time. 1 will familiarize myself promptly with such rules and regulations and will abide and be bound by the rules and regulations now and hereafter in effect. I understand that I am obligated to follow the policies/procedures listed below for AAA Staffing, as well as any policies/procedures for the company for which I am assigned.

II. I understand this acknowledgment is not intended to be and does not constitute a contractual arrangement or agreement of any kind between AAA Staffing and its employees. I understand my employment is “atwill” and not for a specified or definite term and that I may resign and may be discharged, at any time, for any reason, with or without good cause and with or without prior notice. This acknowledgment does not limit my right or the company’s right to terminate employment at any time. No representative of the company, other than the Owners, have any authority to enter into an employment contract or change the nature of the employment relationship and even then, it must be in written format. The written format must contain signatures from both parties.

III. I understand that AAA Staffing is an Equal Opportunity Employer. The goal of the company policy is to provide equal employment opportunities according to any applicable federal, state or local ordinances without regard to race, color. religion, sex, national origin, age, disability, veteran status, or any other illegal basis. We will not unlawfully consider any of these factors.

IV. I understand the Company has an Open Door Policy. It is my responsibility to actively communicate to my immediate supervisor or manager when I have concerns or grievances that need to be addressed. I understand I should attempt to resolve my concerns, grievances etc. with my immediate supervisor or manager first, but if there is no resolution or if there is a conflict with my immediate supervisor or manager. I have the option to contact any member of the management team regarding any concerns or grievances to be addressed. I understand that it is my responsibility to communicate all grievances/concerns/complaints to AAA Staffing and to the company for which I am assigned.

V. I understand the Company has a Harassment/Discrimination Policy. Harassment/discrimination including Sexual Harassment in the workplace is illegal and against company policy. Harassment is defined as any unwanted or unwelcome sexual or non-sexual advances, requests for sexual or non-sexual favors or other verbal or physical conduct of a sexual or non-sexual nature that (1) explicitly or implicitly are made a condition of employment, (2) are used as a basis for employment decisions, or (3) create a work environment that interferes with performance. Any violation of this policy will be a serious violation and will result in disciplinary action, up to and including discharge. I understand if I am being harassed. l can make it known to the harasser that the behavior is unwelcome. I understand that I am also responsible for reporting any harassment/discrimination claims to my immediate supervisor or manager, or any member of the management team of AAA Staffing as well as to the company for which I am assigned. Confidentiality will be maintained to the extent possible. Retaliations against employees who report harassment/discrimination claims and who assist in an investigation will not be tolerated.

VI. Harassment/discrimination including sexual harassment in the workplace is illegal and against company policy. Harassment is defined as any unwanted or unwelcome sexual or non-sexual behavior, requests for sexual or non-sexual favors or other verbal or physical conduct of a sexual or non-sexual nature. Any violation of this policy will be considered a serious violation and may result in disciplinary action, up to and including discharge. If you witness or receive a harassment/discrimination complaint from a employee or non-employee, please report it to your supervisor immediately.

 

AAA STAFFING
EMPLOYEE POLICIES AND PROCEDURES
ACKNOWLEDGMENT

 

AFFIDAVIT:

• I certify that the answers given by me to the questions and statements on the employment applications and/or during the employment interview process are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render the employment application and application process void and, if employed, would be cause for my termination. I further agree that AAA Staffing shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me on the employment application or in the employment process.

• I authorize the companies, schools, persons or entities given during the employment process or on the employment application as references or past employers or affiliations to give any information regarding my employment, character qualifications, certifications and licenses and hereby release said companies, schools, persons or entities from all liability for any damage for providing this information. I understand that there may be state and federal requirements as well as insurance and employment requirements that will require periodic checks of all the above referenced sources. If employed, I further authorize periodic checks of all above referenced sources as may be deemed necessary by employer. A favorable result may be a condition of continued employment or commencement of any employment duties where elements are job-related.

• I understand that I may be required to have a medical examination and/or drug and alcohol test. A favorable result on the medical examination and/or drug and alcohol test would be a condition of commencement of any employment duties.

• I understand that my employment is not for a specified or definite term and that I may resign, or I may be discharged at any time, for any reason, with or without good cause and with or without prior notice. I further understand that this policy cannot be changed or amended except by written agreement signed by me and by a corporate officer.

• My employment shall be in accordance with the terms of the employment application, all safety and incident reporting rules, and all other Company rules and regulations.

• During the course of employment, there is a potential to have contact with many “customers”. These “customers” may include, but are not limited to: visitors, vendors, consultants, contractors, service persons, customers, etc. This contact may include, but not be limited to: personal contact, written communication, telephone communications, e-mail communications or telecommunications of any type. The image of our organization is tied to the image of its employees, and to the extent that both of them intertwine, employees have a responsibility to represent the company’s image accordingly. Employees should not have an expectation of privacy with respect to their telephone, e-mail or voicemail communications, telecommunications in general, the contents thereof, work areas or any general business work areas. Passwords are designed to minimize unauthorized access only. Workplace documents and communications are business records subject to possible review by the Company as well as outside parties. If you receive a customer complaint regarding harassment or discrimination, please report it to a member of management immediately. I have had the opportunity to review the basic policies and procedures and acknowledge these policies and procedures and agree to abide by them.

 

AAA STAFFING
EMPLOYMENT TERMS AND CONDITIONS
ACKNOWLEDGMENT

 

I understand that I am not required to work on any particular day and whether I report in to AAA STAFFING is always my choice. Whenever I wish to register my availability to work, I will call the office with my availability. I know that AAA STAFFING is not required to find work for me and is not required to contact me in any way in order to make work available to me. If I do not report to the dispatch call and sign in, AAA STAFFING may assume that I am not available for work on that day.

If I am asked to return to an assignment, I understand that it is my responsibility to notify AAA STAFFING of the duration of the assignment. If I do not report to the office, it will be assumed that I am not available for work.

I understand that any employment with AAA STAFFING is on a day-to-day basis. That is, at the end of the work day, I will be deemed to have quit unless and until I request and receive a work assignment at a later date. I understand I must call the local office to report available for further assignment within 24 hours of completing my assignment. I understand if I fail to do this I may not be eligible for unemployment benefits. I acknowledge that notices pertaining to my availability for employment are posted at the AAA STAFFING office.

I agree that any disputes arising out of my employment, including any claims of discrimination, harassment or wrongful termination that I believe I have against AAA STAFFING and all other employment related issues (excluding only claims arising under the National Labor Relations Act or otherwise within the jurisdiction of the National Labor Relations Board) will be resolved by arbitration as my sole remedy. The arbitration shall be conducted by the American Arbitration Association under its Commercial Arbitration Rules and the decision of the arbitrator shall be final and binding. I understand that AAA STAFFING also agrees to arbitrate in the same manner any claims which the company believes it has against me.

 

AAA STAFFING
CONDITIONS AND CERTIFICATIONS
ACKNOWLEDGMENT

 

In consideration of my employment, I agree to conform to the rules and regulations of AAA STAFFING and I understand that my employment by AAA STAFFING may be terminated at any time by me or AAA STAFFING, with or without notice, for any reason. I understand that no General Manager, Assistant Manager or any other employee or representative of AAA STAFFING other than the President of AAA STAFFING has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to any of the foregoing.

CONFIDENTIALITY STATEMENT: Employees and former employees are prohibited from releasing to any other party any information whatsoever about AAA STAFFING which is of a confidential nature or which could be deemed to constitute a “trade secret.” Employees or former employees are further prohibited from using, in any manner whatsoever, information which is confidential, proprietary, or privileged, whether for their personal benefit or gain, or for that of any other person. Any information which has not been disclosed publicly in writing should be treated as confidential and proprietary.

I understand the duties, including physical requirements of the position for which I am applying with AAA STAFFING and I certify that I am capable of performing the required tasks with or without reasonable accommodation. If any accommodation is necessary, I will describe the proposed accommodation on an attached sheet.

 

RELEASE OF CLAIMS AGAINST AAA STAFFING CUSTOMERS

 

I am either a temporary worker for AAA STAFFING (the “Company”) or am applying for temporary work assignments with the Company.

I understand that the Company provides temporary workers for its customers to work at the customers’ project site. In accepting any work assignment, I acknowledge that I am a temporary employee of the Company and am not an employee of the Company’s customer.

If I am ever injured in the course of my work for the Company, I agree that I will look only to the Company’s Workers’ Compensation coverage and not to the Company’s customer for any recovery. For myself, and on behalf of my heirs, executor, personal representative and assigns, I waive, release and forever discharge any claim that I may now have or that may later accrue against any customer of the Company which directly or indirectly arises out of any injuries which may occur to me while on a temporary work assignment for the Company.

In signing this Release, I understand that I am not waiving or releasing any claims which I may have against the Workers’ Compensation coverage provided by the Company.

 

EXHIBIT B
SAMPLE BENEFITS WAIVER FOR ASSIGNED EMPLOYEES
(FOR ARIZONA EMPLOYEES ONLY)

 

In consideration of my assignment to Client by Staffing Firm, I agree that I am solely an employee of Staffing Firm for benefits plan purposes and that I am eligible only for such benefits as Staffing Firm may offer to me as its employee. I further understand and agree that I am not eligible for or entitled to participate in or make any claim upon any benefit plan, policy, or practice offered by Client, its parents, affiliates, subsidiaries, or successors to any of their direct employees, regardless of the length of my assignment to Client by Staffing Firm and regardless of whether I am held to be a common-law employee of Client for any purpose; and therefore, with full knowledge and understanding, I hereby expressly waive any claim or right that I may have, now or in the future, to such benefits and agree not to make any claim for such benefits.

 

EXHIBIT C
CONFIDENTIALITY AGREEMENT FOR ASSIGNED EMPLOYEES
(FOR ARIZONA EMPLOYEES ONLY)

 

As a condition of my assignment by Staffing Firm to Client, I hereby agree as follows: I will not use, disclose, or in any way reveal or disseminate to unauthorized parties any information I gain through contact with materials or documents that are made available through my assignment at Client or which I learn about during such assignment. I will not disclose or in any way reveal or disseminate any information pertaining to Client or its operating methods and procedures that come to my attention as a result of this assignment. Under no circumstances will I remove physical or electronic documents or copies of documents from the premises of Client. I understand that I will be responsible for any direct or consequential damages resulting from any violation of this Agreement. The obligations of this Agreement will survive my employment by Staffing Firm.

  

CONSENT TO DRUG/ALCOHOL TESTING IN THE EVENT OF WORK-RELATED INJURY OR ILLNESS

 

I understand that. as part of its regular employment policy, AAA STAFFING requires any employee who suffers a work-related injury or illness to be tested for the presence of drugs and/or alcohol. This testing is to be done at the location where initial treatment for the injury/illness is provided, and is to be conducted in accordance with acceptable medical procedures I understand that if I refuse to submit to testing, it will be considered as refusal to comply with a reasonable request by my employer and will be cause for dismissal. I further agree to hold harmless AAA STAFFING, its principles. agents and clients for any and all consequences arising from my testing positive for the use and/or influence of drugs or alcohol at the time of my injury or illness.

 

DRUG TESTING

 

I fully understand that AAA STAFFING has strict policies that ban the use of unauthorized drugs. The ban includes the consumption of alcohol immediately prior to the beginning and during all scheduled work days. NO DRUGS NO ALCOHOL! I am aware that AAA STAFFING has a random drug testing policy. Drug testing may also be required by some clients and cooperation is required as a condition of employment. In the event of a work-related accident, an immediate drug/alcohol test is required.

 

SEXUAL HARASSMENT

 

I understand that AAA STAFFING has zero tolerance for sexual harassment and workplace violence. The penalty for either is immediate termination.

 

CRIMINAL BACKGROUND CHECK

 

I understand and agree that AAA STAFFING may conduct a criminal background check through the court system. The signature below authorizes AAA STAFFING to conduct this inquiry.

Have you ever been charged with a Felony or Misdemeanor?

If yes, please explain:

Have you ever been convicted of a Felony or Misdemeanor?

If yes, please explain:

Conviction will not necessarily preclude AAA Staffing from considering a person for the position applied for.

Falsifying any of the above information will result in a disqualification for the position applied for or immediate termination.

 

AGREEMENT TO WORK FOR AAA STAFFING. LTD.

 

I understand and agree that for 90 days after the last day for which hours are scheduled and worked using the employment service provided by AAA STAFFING I cannot accept permanent or temporary employment from any client or sister company to that client for whom I have worked. Clients also agree to this provision by signing the official time sheet each week (Please read and thoroughly understand “Terms’ on back of “Official Weekly Time Sheet”). There are NO FEES for providing this employment service. Therefore, employees and clients utilizing AAA’s services must abide by the work agreement specified on the back of “Official Weekly Time Sheet.”

 

JOB SAFETY COMPLIANCE

 

I understand the importance of reporting injuries to AAA STAFFING as soon as they may occur. In the event of an on-the-job injury, I understand that it is my responsibility to report the injury to a representative of the client for whom I am working and then to immediately report the injury to the office of AAA STAFFING. I also understand that it is my responsibility to report unsafe working conditions and/or the lack of proper safety equipment.

 

FORM I-9

 

Please Note: This is an online version of the Department of Homeland Security Form I-9. By signing this online version, you agree to use this form just as you would the PDF version. If you prefer, you may sign the PDF version of Form I-9 and fax it to (281) 584-9680 or email it to AAA Staffing.

 

 

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.

 

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

 

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)

 

Last Name (Family Name)

First Name (Given Name)

Middle Initial

Other Last Names Used (if any)

Address (Street Number and Name)

Apt. Number

City or Town

State

Zip code

Date of Birth (mm/dd/yyyy)

Last 4 of U.S. Social Security Number (XXXX)

Employee’s E-mail Address

Employee’s Telephone Number

 

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

 

I attest, under penalty of perjury, that I am (check one of the following boxes):

 

1. A citizen of the United States
2. A noncitizen national of the United States (See instructions)
3. A lawful permanent resident (Alien Registration Number/USCIS Number):
4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):
Some aliens may write “N/A” in the expiration date field. (See instructions)

 

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:
OR
2. Form I-94 Admission Number:
OR
3. Foreign Passport Number:
Country of Issuance:

 

QR Code – Section 1
Do Not Write In This Space

 

 

 

Preparer and/or Translator Certification (check one):
I did not use a preparer or translator.
A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

 

If you are using the assistance of a preparer and/or translator, please sign the PDF version of Form I-9 and fax it to (281) 584-9680 or email it to AAA Staffing.

 

FORM W-4

 

Please Note: This is an online version of the Department of Treasury Form W-4. By signing this online version, you agree to use this form just as you would the PDF version. If you prefer, you may sign the PDF version of Form W-4 and fax it to (281) 584-9680 or email it to AAA Staffing. For a copy of the Personal Allowance Worksheet, reference pages 3 and 4 of Form W-4. For Privacy Act and Paperwork Reduction Act Notice, see page 4.

 

Form W-4 (2019)

Future developments. For the latest information about any future developments related to Form W-4, such as legislation enacted after it was published, go to www.irs.gov/FormW4.

Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. You may claim exemption from withholding for 2019 if both of the following apply.

• For 2018 you had a right to a refund of all federal income tax withheld because you had no tax liability, and

• For 2019 you expect a refund of all federal income tax withheld because you expect to have no tax liability.
If you’re exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2019 expires February 17, 2020. See Pub. 505, Tax Withholding and Estimated Tax, to learn more about whether you qualify for exemption from withholding.

General Instructions

If you aren’t exempt, follow the rest of these instructions to determine the number of withholding allowances you should claim for withholding for 2019 and any additional amount of tax to have withheld. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

You can also use the calculator at www.irs.gov/W4App to determine your tax withholding more accurately. Consider using this calculator if you have a more complicated tax situation, such as if you have a working spouse, more than one job, or a large amount of nonwage income outside of your job. After your Form W-4 takes effect, you can also use this calculator to see how the amount of tax you’re having withheld compares to your projected total tax for 2019. If you use the calculator, you don’t need to complete any of the worksheets for Form W-4.

Note that if you have too much tax withheld, you will receive a refund when you file your tax return. If you have too little tax withheld, you will owe tax when you file your tax return, and you might owe a penalty.

Filers with multiple jobs or working spouses. If you have more than one job at a time, or if you’re married and your spouse is also working, read all of the instructions including the instructions for the Two-Earners/Multiple Jobs Worksheet before beginning.

Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you might owe additional tax. Or, you can use the Deductions, Adjustments, and Other Income Worksheet on page 3 or the calculator at www.irs.gov/W4App to make sure you have enough tax withheld from your paycheck. If you have pension or annuity income, see Pub. 505 or use the calculator at www.irs.gov/W4App to find out if you should adjust your withholding on Form W-4 or W-4P.

Nonresident alien. If you’re a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Specific Instructions

Personal Allowances Worksheet

Complete this worksheet on page 3 first to determine the number of withholding allowances to claim.

Line C. Head of household please note: Generally, you can claim head of household filing status on your tax return only if you’re unmarried and pay more than 50% of the costs of keeping up a home for yourself and a qualifying individual. See Pub. 501 for more information about filing status.

Line E. Child tax credit. When you file your tax return, you might be eligible to claim a credit for each of your qualifying children. To qualify, the child must be under age 17 as of December 31 and must be your dependent who lives with you for more than half the year. To learn more about this credit, see Pub. 972, Child Tax Credit. To reduce the tax withheld from your pay by taking this credit into account, follow the instructions on line E of the worksheet. On the worksheet you will be asked about your total income. For this purpose, total income includes all of your wages and other income, including income earned by a spouse, during the year.

Line F. Credit for other dependents. When you file your tax return, you might be eligible to claim a credit for each of your dependents that don’t qualify for the child tax credit, such as any dependent children age 17 and older. To learn more about this credit, see Pub. 505. To reduce the tax withheld from your pay by taking this credit into account, follow the instructions on line F of the worksheet. On the worksheet, you will be asked about your total income. For this purpose, total income includes all of your wages and other income, including income earned by a spouse, during the year.

Line G. Other credits. You might be able to reduce the tax withheld from your paycheck if you expect to claim other tax credits, such as the earned income tax credit and tax credits for education and child care expenses. If you do so, your paycheck will be larger but the amount of any refund that you receive when you file your tax return will be smaller. Follow the instructions for Worksheet 1-6 in Pub. 505 if you want to reduce your withholding to take these credits into account.

Deductions, Adjustments, and Additional Income Worksheet

Complete this worksheet to determine if you’re able to reduce the tax withheld from your paycheck to account for your itemized deductions and other adjustments to income such as IRA contributions. If you do so, your refund at the end of the year will be smaller, but your paycheck will be larger. You’re not required to complete this worksheet or reduce your withholding if you don’t wish to do so.

You can also use this worksheet to figure out how much to increase the tax withheld from your paycheck if you have a large amount of nonwage income, such as interest or dividends.

Another option is to take these items into account and make your withholding more accurate by using the calculator at www.irs.gov/W4App. If you use the calculator, you don’t need to complete any of the worksheets for Form W-4.

Two-Earners/Multiple Jobs Worksheet

Complete this worksheet if you have more than one job at a time or are married filing jointly and have a working spouse. If you don’t complete this worksheet, you might have too little tax withheld. If so, you will owe tax when you file your tax return and might be subject to a penalty.

Figure the total number of allowances you’re entitled to claim and any additional amount of tax to withhold on all jobs using worksheets from only one Form W-4. Claim all allowances on the W-4 that you or your spouse file for the highest paying job in your family and claim zero allowances on Forms W-4 filed for all other jobs. For example, if you earn $60,000 per year and your spouse earns $20,000, you should complete the worksheets to determine what to enter on lines 5 and 6 of your Form W-4, and your spouse should enter zero (“-0-”) on lines 5 and 6 of his or her Form W-4. See Pub. 505 for details.

Another option is to use the calculator at www.irs.gov/W4App to make your withholding more accurate.

Tip: If you have a working spouse and your incomes are similar, you can check the “Married, but withhold at higher Single rate” box instead of using this worksheet. If you choose this option, then each spouse should fill out the Personal Allowances Worksheet and check the “Married, but withhold at higher Single rate” box on Form W-4, but only one spouse should claim any allowances for credits or fill out the Deductions, Adjustments, and Additional Income Worksheet.

Instructions for Employer

Employees, do not complete box 8, 9, or 10. Your employer will complete these boxes if necessary.

New hire reporting. Employers are required by law to report new employees to a designated State Directory of New Hires. Employers may use Form W-4, boxes 8, 9, and 10 to comply with the new hire reporting requirement for a newly hired employee. A newly hired employee is an employee who hasn’t previously been employed by the employer, or who was previously employed by the employer but has been separated from such prior employment for at least 60 consecutive days. Employers should contact the appropriate State Directory of New Hires to find out how to submit a copy of the completed Form W-4. For information and links to each designated State Directory of New Hires (including for U.S. territories), go to www.acf.hhs.gov/programs/css/employers.

If an employer is sending a copy of Form W-4 to a designated State Directory of New Hires to comply with the new hire reporting requirement for a newly hired employee, complete boxes 8, 9, and 10 as follows.

Box 8. Enter the employer’s name and address. If the employer is sending a copy of this form to a State Directory of New Hires, enter the address where child support agencies should send income withholding orders.

Box 9. If the employer is sending a copy of this form to a State Directory of New Hires, enter the employee’s first date of employment, which is the date services for payment were first performed by the employee. If the employer rehired the employee after the employee had been separated from the employer’s service for at least 60 days, enter the rehire date.

Box 10. Enter the employer’s employer identification number (EIN).

 

 

1.

Your first name and middle initial

Last Name

Home address (number and street or rurual route)

City or town, state, and ZIP code

 

2.

Last Four of Your Social Security Number (XXX)

 

3.

Single
Married
Married, but withhold at higher Single rate.
Note: If married filing separately, check “Married, but withhold at higher Single rate.”

 

4.

If your last name differs from that shown on your social security card, check here. You must call 800-772-1213 for a replacement card.

 

5.

Total number of allowances you’re claiming (from the applicable worksheet on the following pages) …

 

6.

Additional amount, if any, you want withheld from each paycheck ………….. $

 

7.

I claim exemption from withholding for 2019, and I certify that I meet both of the following conditions for exemption.
• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
If you meet both conditions, write “Exempt” here ……………

 

8.

Employer’s name and address (Employer: Complete boxes 8 and 10 if sending to IRS and complete boxes 8, 9, and 10 if sending to State Directory of New Hires.)

 

9.

First date of employment (Completed by Employer)

 

10.

Employer identification number (EIN) (Completed by Employer)

 

Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

 

AAA STAFFING
Employee Direct Deposit Enrollment Form

 

To enroll in Full Service Direct Deposit, simply fill out this form. If depositing to a savings account, ask your bank to give you the Routing/Transit Number for your account. It isn’t always the same as the number on a savings deposit slip. This will help ensure that you are paid correctly. Below is a sample check MICR line, detailing where the information necessary to complete this form can be found.

 

Employee Direct Deposit Enrollment Form

 

IMPORTANT! Please read before completing and submitting.

I hereby authorize AAA STAFFING to deposit any amounts owed me, as instructed by my employer, by initiating credit entries to my account at the financial institution (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by AAA STAFFING to my account. In the event that AAA STAFFING deposits funds erroneously into my account, I authorize AAA STAFFING to debit my account for an amount not to exceed the original amount of the erroneous credit. This authorization is to remain in full force and effect until AAA STAFFING and Bank have received written notice from me of its termination in such time and in such manner as to afford AAA STAFFING and Bank reasonable opportunity to act on it (7 business days minimum).

 

LAST NAME

FIRST NAME (Must Match Bank Account)

LAST FOUR OF YOUR SOCIAL SECURITY NUMBER

EMAIL ADDRESS

CELL PHONE

DATE
October 16, 2019

NEW EMPLOYEE
CURRENT EMPLOYEE UPDATING INFO

BANK NAME

TYPE OF BANK ACCOUNT

CHECKING ACCOUNT
SAVINGS ACCOUNT
PREPAID CARD

ROUTING/TRANSIT NUMBER (9 DIGITS)

ACCOUNT NUMBER

 

• AAA Staffing will email the employee a password protected paystub (.pdf) on every Friday payday. Your emailed paystub password is the first four letters of your last name (lowercase) and the last four digits of your social security number. For example: George Washington SSN 123-­-45-­-6789 will have password: wash6789

• Mailed paychecks will delivered via the US Postal Service from Houston, TX and will be void and reissued after 30 days. To avoid delays please enroll in direct deposit today.

 

EMPLOYEE SIGNATURE VERIFICATION

 

My signature indicates that I have read and agree to the above statements and have received a copy of the “New Health Insurance Marketplace Coverage Options” form.

 

• Questions? Call (281) 584-0830 or toll free at 1-877-866-0830, Fax 1-877-464-1866.

 

October 16, 2019
Employee’s signature (This form is not valid unless you sign it.)

Leave this empty:

Signature Certificate
Document name: Application for Employment
Unique Document ID: 0330eb5d1507859acafcdf575ea3cc73396846a0
Timestamp Audit
April 2, 2018 5:06 pm CDTApplication for Employment Uploaded by Anne O'Connell - adresponses@aaastaffing.com IP 205.251.150.234