Thank you for the opportunity to help you further your career.

 

GLOBAL EMPLOYMENT SOLUTIONS

 

CERTIFICATION

           I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize MasterStaff, Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, the employment relationship will be "at-will". In other words, the relationship will be entirely voluntary in nature and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Morever, no agent, representative, or employee of MasterStaff, Inc., has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFACTION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Please list three professional references.

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release

 

of criminal records and verify this information. I understand that if employed, my employment will not be for any fixed period of time, and may be terminated by the company at any time. I also authorize MasterStaff, Inc. to release the information contained herein and its findings and work history of my employment to other firms or person upon request.

I do hereby authorize MasterStaff, Inc. to examine any and all criminal, judicial judgments and my job history on file in any state in the United States. In doing so, I understand that I am waiving my right of confidentiality concerning my prior employment or criminal background.

I hereby authorize MasterStaff, Inc. or any medical facility they deem fit, to collect the specimen requested, in accordance with its established procedures, and to turn that specimen over for drug testing. I also authorize that the results be released to MasterStaff, Inc. upon completion of the testing. I further authorize the sharing of results of my drug test with that company that has requested I be drug tested. I knowingly consent to this test and agree to hold harmless MasterStaff, Inc. and any of its employees, the medical review officer, and whatever medical facility has been chosen for the testing.

I verify that the specimen given for testing (blood, urine, hair) is my own and has not been obtained from any other person for the purpose of testing.

Investigation Consent Form and Receipt of Summary of FCRA Rights

I understand and acknowledge that an investigative consumer report may be obtained for employment purposes. I authorize the company I have made application with, or its designated agent, to conduct pre-employment or other employment related inquiries after I am hired (to the extent allowed by law) and authorize any past or present employer, or other business, governmental agency or individual contacted to supply the requested information and documents concerning me and to provide full and complete disclosure. I understand that all pre-employment screening activities are conducted in compliance with ADA,EEOC and the Fair Credit Reporting Act (FCRA) requirements. I release from liability the company I have made application with, and its representatives for gathering and using such information. I fully release the person or entity providing the information of any right or claim of confidentiality concerning disclosure of the information requested below or any and all claims, actions, or causes of action which may arise as a consequence of the release of such information as may be requested concerning: (i) Complete background reference and work history checks; (z) Criminal and civil litigation history information or any other public records (such as driving records, liens, judgments, and sex offender status); (3) Credit reports, academic achievement, professional licensure, bankruptcy filings; (4) Previous incidents of alleged sexual or racial harassment; (5) Previous incidents of violent behavior and/or suspected dishonest acts; (6) Results of previous drug testing within the past two years if positive for illegal substances; (7) Eligibility for rehire and circumstances of previous separations from employment; (8) Social Security Number verification; and (9) information concerning any or all worker's compensation claims if a conditional offer of employment has been made. I request that any law enforcement agency, institution, information service bureau, school, employer, reference, or insurance company contacted pursuant to this investigation consent form cooperate fully and completely in responding to the inquiries. By my signature below, I acknowledge that I have received a Summary of my Rights under the Fair Credit Reporting Act (FCRA).

 

TO BE COMPLETED BY EMPLOYEE

 

PLEASE ANSWER "YES" OR "NO" TO THE FOLLOWING QUESTIONS.

(If answer is "yes", please provide additional information as outlined on page 2)

Please answer the following questions if you were living in the Hurricane Sandy core disaster area on October 27, 2012

I certify that this information is true and correct to the best of my knowledge.

Pre-Screening Notice and Certification Request for

the Work Opportunity Credit

►Information about Form 8850 and its separate instructions is at www.irs.govIform8850.

 

•  I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9 months during the past 18 months.

•  I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least a 3-month period during the past 15 months.

• I was referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program, or the Department of Veterans Affairs.

•  I am at least age 18 but not age 40 or older and I am a member of a family that:

a. Received SNAP benefits (food stamps) for the past 6 months; or

b. Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is no longer eligible to receive them.

•  During the past year, I was convicted of a felony or released from prison for a felony.

• I received supplemental security income (SSI) benefits for any month ending during the past 60 days.

•  I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during the past year. 

• Received TANF payments for at least the past 18 months; or

• Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended during the past 2 years; or

• Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be made.

Signature—All Applicants Must Sign

Under penalties of perjury, I declare that I gave the above information to the employer on or before the day I was offered a job, and it is, to the best of my knowledge, true, correct, and complete.

For Employer's Use Only

If, based on the individual's age and home address, he or she is a member of group 4 or 6 (as described under Members ofTargeted Groups in the separate instructions), enter that group number (4 or 6)

Date applicant:

Under penalties of perjury, I declare that the applicant provided the information on this form on or before the day a job was offered to the applicant and that the information I have furnished is, to the best of my knowledge, true, correct, and complete. Based on the information the job applicant furnished on page 1, I believe the individual is a member of a targeted group. I hereby request a certification that the individual is a member of a targeted group.

Approved Source Documents

Instructions:

The applicant or employer is requested to provide documentary evidence to substantiate the YES answers. Please fist or describe the documentary evidence that will be provided to the SWA.

 

*Where a Federal/State/Local Government, School I.D. Card, or Work Permit does not contain age or birth date, another valid document must be obtained to verify an individual's age.

By entering this code the recruiter verifies that the applicant has fully completed part 1 of the application packet and has interviewed the applicant. The recruiter is willing to offer a position pending the completion of application part 2.

 

MASFERSTAFF, INC. FIELD EMPLOYEE HANDBOOK

The purpose of this handbook is to provide you with very important information regarding general employment policies and rules of MasterStaff, Inc. It applies to all MasterStaff, Inc. employees. Please read this handbook very carefully so that you are familiar with its contents. This information was created by MasterStaff, Inc. and should only be used for employment with MasterStaff, Inc. The policies and procedures set forth in this handbook are subject to amendment by MasterStaff, Inc. without prior notice. Generally, changes to the handbook will be posted. The handbook is not intended to be contractual in nature or to form the basis or an expressed or implied contract and should not be relied upon as such. It is to express policy and intent of MasterStaff, Inc. that the employment relationship between employer and employee is one of employment at-will.

EQUAL OPPORTUNITY EMPLOYMENT POLICY

MasterStaff, Inc. through responsible managers, shall recruit, hire upgrade, train and promote in all job titles without regard to race, color, religion, sex, national origin, age (40 and over), disability, veteran status or other characteristics protected by law. In addition, qualified applicants and employees with disabilities will be free from discrimination (based on their disability) in hiring, firing, promotion, discharge, pay, job training, fringe benefits, and other aspects of employment. Also, upon request by an employee, MasterStaff, Inc.  will provide qualified applicants and employees with disabilities with necessary reasonable accommodations that do not impose undue hardship.

Managers shall ensure that all personnel actions such as compensation, benefits, layoffs, company- sponsored training, social and recreational programs shall be administered without regard to race, color, religion, national origin, sex, age (40 and over), disability, veteran status or other characteristics protected by law. Mangers shall take affirmative action to ensure that minority group individuals, females, veterans, and qualified disabled persons and disabled veterans are introduced into the workforce and that these employees are encouraged to aspire for promotion and are considered as promotional opportunities arise.

The primary purpose for the implementation and supervision of the policy rests with the company.

ANTI—HARASSMENT POLICY

MasterStaff, Inc. acknowledges that every employee has the right to work in an environment free of sexual or any other unlawful form of harassment. Every employee has a responsibility and obligation to conduct himself or herself accordingly. We believe that all employees should be treated with respect. We will not permit harassment by managers, employees, customers, clients or vendors. We are committed to having a workplace free from harassment.

 

Sexual harassment occurs when an employee is subjected to unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature and when (1) submission by the employee to such conduct is made either explicitly or implicitly term or condition of employment, (2) submission of or rejection of such conduct by the employee is used as the basis for employment decisions affecting that employee, or (3) such conduct has the purpose or effect of unreasonably interfering with the employee's work performance or creates and intimidating, hostile or offensive working environment.

If you feel you have been subjected to sexual harassment or any other unlawful form of harassment in the workplace, you should contact your supervisor and the Regional Manager of MasterStaff, Inc. to discuss the situation and bring the matter to the company's attention.

The Regional Manager or a designated member of management will investigate the complaint.  Any employee found to have violated this policy will be subjected to disciplinary action up to and including termination.

In addition, the company will ensure that there will be no adverse job-related consequences to anyone as the result of bringing concerns about sexual harassment or any other form of harassment to the company's attention, regardless of the outcome of the investigation.

Sexual harassment and other unlawful forms of harassment are not only against company policy, they are also a violation of Title VII of the Civil Rights Act of 1964 and other state and local laws.

MasterStaff, Inc. will not permit the following types of conduct;

 

•   Unwelcome slurs, jokes, and harassing comments about someone's race, color, religion, sex, national origin, citizenship, age, disability, veteran status, or any other protected status.

•   Unwelcome graffiti, cartoons, drawings, or other written comments about someone'srace, color, creed, religion, sex, national origin, citizenship, age, disability, veteran status, or any other legally protected status.

•   Unwelcome sexual advances, repeated unwelcome request for dates, and requests for sexual favors. Unwelcome or offensive touching or other physical conduct directed at an employee because of their race, color, creed, religion, sex, national origin, citizenship, age, disability, veteran status or any other legally protected status.

•   Threatening or requiring an employee to submit to sexual advances in return for employment benefit.

•   Retaliation for having reported possible harassment.

We are committed to making sure employees are not harassed in any way while working for MasterStaff, Inc. However, we need your help to make sure we have a workplace free from harassment. We need to address situations as soon as they occur. You should report any possible harassment to one of the following people:

•      Your supervisor from the company that you are placed at to work

•       MasterStaff, Inc. Internal Management — MasterStaff, Inc. Recruiters

All reports of possible harassment will be investigated immediately once MasterStaff, Inc. Internal Management and Recruiters have been made aware of the harassment claim. We will keep the investigation confidential to the extent possible under the circumstances. We encourage employees to report any potential harassment.

FILING A FORMAL COMPLAINT

If there is anything that you feel needs to be brought to our attention, we have an official formal complaint form that needs to be filled out and turned in to either a MasterStaff, Inc. internal management team member or a MasterStaff, Inc. recruiter. We will do what we can, within reason, to fix the situation that you are uncomfortable with, up to and including removing you from the company in question and providing you with another opportunity. We are unable to do anything regarding the situation unless a formal complaint is completed and submitted to MasterStaff, Inc.

By signing off on this handbook, you are agreeing to allow MasterStaff, Inc. the opportunity to correct the situation before you contact a legal representative.

RULES AND PROCEDURES

I will agree to abide by all the following rules of safety while working with MasterStaff, Inc.

I WILL NOT:

 

1. Report to work under the influence of intoxicants or non-prescribed drugs.  Prescribed drugs affecting the working ability of the employee will require time off until released to work by the attending physician.

2.     Non-observance of plant safety rules as posted.

3. Engage in or be the cause of threatening, intimidating, coercing or interfering with fellow employees or management on premises at any time.

4.     Provide poor workmanship.

5.     Fight on company premise of place I have been placed at and MasterStaff, Inc. offices.

6.     Create an unsanitary or unsafe condition in the work area or facilities of the business I am placed to work at and MasterStaff, Inc. premises.

7. Create any false statements on the application for employment.

8. Engage or create any horseplay on company property of any kind.

9. Gamble, including games of chance, operate pools, lotteries, etc. on company property I am placed at or MasterStaff, Inc. premises.

10. Clock-in for another employee or alter their timecard in any way. Have another employee clock-in for myself.

11. Misuse company machinery, tools or property.

12. Be insubordinate.

13. Have unexcused absences and unexcused tardies.

14. Engage in or create any incident or have immoral behavior as determined by law or company policy.

15. Fail to call-in or not report to work.

16. Deliberately interrupt the company's operation or production.

17. Engage in or create any act that endangers the life or safety of any employee, manager, etc.

18. Give out any confidential proprietary MasterStaff, Inc. information to competitors or other organizations or to unauthorized company employees; breach of confidentiality of personal information.

19. Engage in the act of sabotage; negligently causing the destruction or damage of company property, fellow employee property or the property of the company at which I have been placed.

20. Engage in or be the one to steal (theft) or have unauthorized possession of company property or the property of fellow employees; unauthorized possession or removal of any company property, including documents from the premises without prior permission; unauthorized use of company equipment or property for personal reasons; using company equipment for personal profit.

21. Be dishonest, falsify or misrepresent on your application for employment or other work records; lie about sick or personal leave; falsify reason for a leave of absence or other data requested by the company; alter any company records or other documents.

22. Spread malicious gossip or rumors; engage in behavior which creates discord and lack of harmony; interfere with another employee's work while on the job; restrict work output or encourage others to do the same.

23. Sleep or loiter during work hours.

24. Use obscene or abusive language toward any manager, employee or customer; be indifferent or rude toward a customer or fellow employee; and engage in or create any disorderly or antagonistic conduct on company premises.

25. Speed or be careless when driving my vehicle on company property or operating any type of motorized and/or equipment in general.

26. Fail to immediately report damage to company equipment.

27. Engage in and/or create any act of harassment, sexual, racial, etc.; tell sexist or racist jokes, make racial or ethnic slurs.

28. Send unprofessional, discriminatory or offensive material via company email to customers, vendors or other employees.

29. Fail to report any injury within (24) twenty-four hours to MasterStaff, Inc.

MASTERSTAFF. INC. SUBSTANCE ABUSE POLICY

It is the policy of MasterStaff, Inc. to help provide a drug free environment for our clients and our employees. With this goal and because of the serious drug abuse problem in today's workplace, we are establishing the following policy for existing and future employees of MasterStaff, Inc.

MasterStaff, Inc. explicitly prohibits:

The use, possession, solicitation for or sale of narcotics or other illegal drugs, alcohol or prescription medication without a prescription on company or customer premises or while performing on assignment. Being impaired or under the influence of legal or illegal drugs or alcohol off the company premises that adversely affects the employee's work performance, his or her own or other's safety at the workplace or the employer's reputation.

MasterStaff, Inc. may drug test using S.A.M.H.S.A. standards by three methods:

PRE-EMPLOYMENT - As is required by MasterStaff, Inc.

RANDOM -  A random unannounced selection of employees for testing.

FOR CAUSE - When it is the company's belief that a drug problem exists.

(Such as evidence of drugs, accidents, injuries in the workplace fights or other behavioral symptoms of drug abuse and/or negative performance. Employees of this staffing company who refuse to submit to drug testing, test positive or admit to substance abuse will be terminated. Also, employees who test positive or admit to substance abuse will be referred to local public agencies that provide rehabilitation and counseling services. The results of all drug testing will be treated confidentially, and not for the purpose other than for MasterStaff, Inc. to make employment related decisions).

PAYROLL

MasterStaff, Inc. agrees to pay you weekly, with your first check being withheld one (1) week. MasterStaff, Inc. does not specify a day you will receive your check, as each company is different. You should be told your payday can fluctuate depending on holidays, payroll discrepancies between the company and the employee, or issues regarding overnight or the postal service delivery times.

You will be placed on a pay card or direct deposit.

•   Direct deposit will go directly into your checking or savings account and is of no cost to you. You must supply MasterStaff, Inc. with a voided check or statement from your bank verifying your account and routing number.

•   Pay card will have a monthly fee that will be deducted out of your pay card account and additional fees depending on how you wish to use your card.

VOLUNTARILY QUITTING YOUR ASSIGNMENT

The following are considered voluntarily quitting or ending your own assignment with MasterStaff, Inc. You will not be eligible for unemployment benefits if you commit one of the following infractions:

1.     Failure to show up to your job. (No call, No Show) and you did not notify a MasterStaff, Inc. representative before your shift was due to start.

2.  Walking off the job at any time, for any reason, and not having notified a MasterStaff, Inc. representative before you left the company where have been placed.

MasterStaff, Inc. requires a 24-hour notice before voluntarily ending your own assignment.  You must inform MasterStaff, Inc.

 

POLICIES FOR EMPLOYMENT

•   By completing a MasterStaff, Inc. application, this does not guarantee you employment through our company. MasterStaff, Inc. does not require applicants to pay for our services, therefore, we are not required to provide you with employment.  As an equal opportunity employer, MasterStaff, Inc. operates in Tennessee which is an "at will" employment state.

•   If you fail to return any form of equipment (work boots, security/time clock badges and/or any items given to you by the company you are placed at and/or MasterStaff, Inc., the dollar amount for those missing items will be deducted from your last check.

•   All employees are responsible for keeping track of their own time.  It is ultimately your responsibility to double check what time is recorded for you at the company you are placed. You need to cross reference that each week with your own records for accuracy. Any missed punches or timesheets filled out incorrectly will not be adjusted until they are approved.

•   MasterStaff, Inc. has a "Zero Tolerance Substance Abuse Policy". If you fail a pre-screen drug test you will be ineligible for re-hire at MasterStaff, Inc. for a period of 5 months. If you fail a random drug test, post-accident or incident mandatory test you will be terminated permanently from MasterStaff, Inc.

•   All injuries must be reported immediately to your supervisor and MasterStaff, Inc. You have 24 hours to report any injury sustained at work. You may be terminated if you do not report an injury within the 24-hour timeframe.  For all injuries that occur after 5pm, contact a MasterStaff, Inc. representative immediately.

•   Any questions, concerns or problems arising from your assignment, MUST be directed to MasterStaff, Inc. You are a MasterStaff, Inc. employee, we are here to help you, but we cannot help if we do not know there is a problem.

•   Absences without notification (i.e. doctor's note, court paperwork, etc.) to both MasterStaff, Inc. and your immediate supervisor may result in separation from MasterStaff, Inc.

•   If you have any changes in your status (address, phone number, dependents etc.) you must notify MasterStaff, Inc. immediately.

•   It is your responsibility to contact MasterStaff, Inc., if your job has been ended by the company we placed you at to seek further employment. If we do not hear from you within 12 hours of your assignment being ended, we will assume that you are terminating the placement relationship with MasterStaff, Inc. or that you have found other employment.

•   The following are considered "Voluntary Resignations":

1. If you walk off the job at any time, No Call No Show to a job or interview, we will not be able to work with you again.

2. If you have a pattern of tardiness and are in violation of attendance policies, work in an unsatisfactory manner and/or are unwilling to perform assignments that were explained before accepting the position, have occasion of recurring negligence and thoughtlessness, or violate drug policies, you will have ended your own assignment and it will be conserved a voluntary quit and we reserve the right to decide whether or not to inactivate your employment status with MasterStaff, Inc.

3. If you fail to conduct yourself and/or behave in an unprofessional manner i.e., use profane language, sleep on the job, threaten others or use aggressive behavior, we will recognize these acts as reasons for separation.

4.     If you falsify any information on your application or make any attempt to falsify your drug screen, these are reasons for immediate dismissal.

 

 

 

BY SIGNING BELOW, I CERTIFY THAT I UNDERSTAND THE POLICIES ABOVE AND WILL ABIDE BY THEM OR BE TERMINATED.

 

 

RECEIPT FOR EMPLOYEE HANDBOOK

I have received my copy of the MasterStaff, Inc. Employee Handbook.  I have read the handbook and I agree to ask any questions about anything I do not understand. I understand that this handbook is intended as a guide for personnel policies, procedures and general information; and that these guidelines are not intended to be, nor should be construed as, an employment contract.

I understand MasterStaff, Inc., reserves the right to make changes in these guidelines or their applications as it is deemed appropriate, and that these changes may be made with or without prior notice.  I also understand that employment is terminable at the "will" of either the employee or the company at any time and no representative of the company other than the President of MasterStaff, Inc., has any authority to make any contrary agreement.

 

ACKNOWLEDGEMENT OF PROCEDURES

Initial each of the following policies and procedures, sign and date at the bottom.

_

1. I understand MasterStaff, Inc. takes their responsibility as my employer very seriously, and that they have gone to great lengths to provide a safe work environment. If I am injured on the job, MasterStaff, Inc. will deal promptly with legitimate claims and has workers compensation insurance that will pay medical expenses and wages. I also understand that MasterStaff, Inc. has extensive experience investigating claims and will fight fraudulent claims with all available resources.

2. I understand that there are several phone numbers that I am to keep with me at all times to reach MasterStaff, Inc. in case of an injury. I have been provided these numbers at the time of my orientation. I also understand that if I DO NOT personally contact MasterStaff, Inc. at the time of the injury and have approval of where to seek treatment, I will be responsible for all medical bills.

3. MasterStaff, Inc. has a strict "Substance Abuse Policy," and I have signed a consent form to submit to drug testing, I understand that my failure to comply with this agreement will be grounds for my immediate termination or denial of a position with MasterStaff, Inc. as this is a condition of
employment with the company.

4. I understand and will comply with MasterStaff Inc.'s safety rules and regulations and hazardous communication program explained to me In MasterStaff Inc.'s orientation.

5. I am telephone accessible and I have reliable transportation. It is my understanding that I am REQUIRED to notify MasterStaff, Inc. of any change of contact information and phone number.

6. I understand that I am an employee of MasterStaff, Inc. and only MasterStaff, Inc. can

terminate my employment. When an assignment ends, I must call MasterStaff, Inc. for my next job assignment. Failure to do or accept my next job assignment will indicate that I have voluntarily quit and will not be eligible for unemployment benefits.

7. I understand that I am expected to complete any job assignment I accept. I understand that if I do not complete or promptly notify MasterStaff, Inc. of my inability to complete the assignment, or if I do not report for my assignment then MasterStaff, Inc. may assume that I have voluntarily quit, and I will not be eligible for unemployment benefits.

8. If, for some unexpected reason, such as an emergency or illness, I cannot make it to work or will be late, I will contact MasterStaff, Inc. BEFORE my shift starts to notify them.

9. I understand MasterStaff, Inc.'s requirements for receiving information, documenting hours worked, the method of providing this information, and the time frame for me to provide this information. I understand MasterStaff, Inc. will not recognize or pay for hours worked by an employee without proper documentation verifying hours worked.

 

10. I have read and fully understand the above statements regarding MasterStaff, Inc.'s policies and procedures and agree to the time. I understand that failure to comply with these policies and procedures could lead to my termination and may jeopardize my insurance benefits.

 

GENERAL SAFETY RULES

MasterStaff, Inc. has developed these safety rules patterned after the Federal OSHA requirements. Read and become familiar with these rules, and other safety rules that apply to your job.

 

1. Report any injury to your employer/supervisor immediately.

2. Report any observed unsafe condition to your employer/supervisor immediately.

3. Horseplay is prohibited at all times.

4. The drinking of alcoholic beverages is not permitted on the job, as there after effects.  Any employee discovered under the influence of alcohol or drugs will not be permitted to work.

5. If you do not have current First Aid Training, do not move or treat an injured person unless there is an immediate peril, such as profuse bleeding or stoppage of breathing.

6. Appropriate clothing and footwear must be worn on the job at all times.

7. Where there exists a hazard of falling objects, an approved hard hat must be worn.

8. Do not perform any task unless you are trained to do so and are aware of the hazards associated with that task.

9. You may be assigned certain personal protective safety equipment.  This equipment should be available for use on the job, be maintained in good condition, and worn when required.

10. Learn safe work practices. When in doubt about performing a task safely, contact your supervisor for instruction and training.

11. The riding of a hoist hook or on other equipment not designed for such purposes, is prohibited at all times.

12. Never remove or by-pass safety devices.

13. Do no approach operating machinery from the blind side; let the operator see you.

14. Maintain a general condition of good housekeeping in all work areas at all times.

15. When operating or driving company equipment, all safety equipment must be worn.

16. Be alert to hazards that could affect you and your co-employees.

17. Obey safety signs and tags.

18. Always perform your assigned task in a safe and proper manner; do not take shortcuts. The taking of shortcuts and the ignoring of established safety rules is a leading cause of employee injury.

I certify that I have read and understand and will abide by the above listed safety rules. Failure to do so may be grounds for termination and may disqualify my insurance benefits.

JOB DUTIES AGREEMENT

 

As a MasterStaff, Inc. employee, I agree to the following:

1. I will not climb onto any surface more than 6 inches off the floor while a MasterStaff, Inc. employee.

2. I will not lift more than Sibs. without written permission from MasterStaff, Inc.

3. I will not drive my vehicle, another employees vehicle, or a company vehicle for the company I am placed at while a MasterStaff, Inc. employee.

 4. I will not perform any task that is out of the scope of the described job duties that I accept without written permission from MasterStaff, Inc.

I understand that if I violate any of the above mentioned requirements, MasterStaff, Inc. is NOT responsible for any injury that occurs as a result. I have read and understand that this is policy. If I choose to perform any of these tasks/duties without proper written permission from MasterStaff, Inc., I am fully responsible and agree to hold harmless MasterStaff, Inc.

WALK—OFF POLICY

 

I understand that if I walk off of my assignment, fail to show up, or quit a job given to me by MasterStaff, Inc., during my probationary period, WITHOUT giving MasterStaff, Inc. a 24-hour notice, I will forfeit my employment with MasterStaff, Inc. and any equipment, etc. that was issued to me and not returned, that the cost will be deducted from my check if not returned immediately.

I understand that failure to provide notice to MasterStaff, Inc. and the company I am assigned to work at, makes these two companies incur costs from lost production time. I am also aware that this jeopardizes future job placements at these companies through MasterStaff, Inc. which harms those that may be looking to find employment at these client companies.

MasterStaff, Inc. agrees to tour facilities before placing employees and will uphold the highest standards when sending employees to work.

I understand that if I walk-off of my assignment without giving MasterStaff, Inc. a 24-hour notice it is a "voluntary quit" from MasterStaff, Inc.

I agree to contact MasterStaff, Inc. immediately if I decide that the position is not what I am looking for and agree to provide them with at least 24-hour notice before ending my own assignment.

If there is a death in the family, a family emergency (documentation must be provided), or other extenuating circumstances that do not allow me to contact MasterStaff, Inc. within the 24-hour period, MasterStaff, Inc. will evaluate these situations on a case-by-case basis.

Upon accepting a job with MasterStaff, Inc., I agree that I have read and understood this policy and agree to the terms above.

KNOWN APPOINTMENTS WITHIN FIRST 90 DAYS

This form is to notify MasterStaff, Inc. of any court dates, scheduled appointments, doctor appointments, vacations, etc., that you may have already scheduled at the time of accepting a job with MasterStaff, Inc.,

IF YOU DO NOT HAVE KNOWN APPOINTMENTS IN THE NEXT 90 MDAYS, SIGN AND DATE BELOW:

I agree that I do not have court dates, scheduled appointments, doctor appointments, vacations, etc. scheduled within the next 90 days.

 

IF YOU HAVE APPOINTMENTS, DOCTOR VISITS, COURT, SCHEDULED VACATIONS ETC., PLEASE LIST AND SIGN BELOW.

I have the following court dates, scheduled appointments, doctor appointments, vacations, etc. scheduled within the next 90 days.

I understand that the above events may have an impact on my employment opportunities. I will make MasterStaff, Inc. aware of any changes in the above dates and times.

 

REPORTING AN ON-THE-JOB INJURY

MasterStaff, Inc. is committed to providing the best possible employment for you and works very hard to make sure that the work environment is as safe as possible. If, however, in spite our best efforts, you are injured on the job, you ARE REQUIRED to follow the procedures detailed below. This is to ensure that you are attended to with the best possible care, your benefits are not denied, and you return to work as soon as possible. Failure to follow ANY of the below procedures could result in denial of your benefits.

1. NOTIFY MasterStaff, Inc. IMMEIDATELY.  You must notify MasterStaff, Inc. BEFORE you seek medical treatment. MasterStaff, Inc. MUST authorize your treatment at the proper medical facilities. Failure to do so will result in denial of payment for treatment. If unconsciousness occurs or the injury is life-threatening, we default to another employer to contact us immediately.

 

2. You MUST go to a MasterStaff, Inc. office for a post-accident drug test, Worker's Compensation orientation and treatment. If injury is non-life threatening, you'll report to a MasterStaff, Inc. office immediately after contacting MasterStaff, Inc.

3. You MUST notify MasterStaff, Inc. of ALL doctor's appointments and have approval prior to your appointment. After EACH doctor's appointment you MSUT bring the doctors paperwork to the MasterStaff, Inc. office and meet with the Risk Manager. MasterStaff, Inc. will NOT pay for any doctor's appointment that has NOT been approved PRIOR to you going.

4. Cooperation with Investigation and Treatment: MasterStaff, Inc. requires that you cooperate fully in all investigations and the progress of your treatment. This means accepting light duty when offered, going to scheduled doctor's appointments and supplying all information needed to process/investigate your claim fully. Failure to comply with any of the above-mentioned items will result in dismissal of Worker's Compensation benefits.

5. Returning to work as soon as you are released from doctor is a requirement. Once you have been fully released by the doctor, you are expected to return to work immediately. Failure to do so will result in termination of Worker's Compensation benefits.

I understand the above terms and conditions and agree to all of them. I understand that if I fail to comply with any of the above procedures and policies, I may forfeit my worker's compensation benefits. I further understand that worker's compensation fraud is a felony and MasterStaff, Inc. investigates all claims and, if fraud has been determined, prosecutes to the fullest extent of the law.

 

 

SMOKING

I have been advised of the State of Tennessee Law which prohibits smoking tobacco products inside places of business, including companies which MasterStaff, Inc. does business.

I understand that smoking is only allowed in designated smoking areas during defined break periods.

I understand that I may receive disciplinary action for willingly violating this state law, up to and including my assignment being ended without warning. I also understand that a knowing violation of this law may be punishable by a civil fine.

I agree to follow this law as set forth by the State of Tennessee. I also agree to follow all company policies regarding smoking and break periods.

 

Employee's Withholding Certificate

►Complete Form W-4 so that your employer can withhold the correct federal income tax from your Pay.

► Give Form W-4 to your employer.

► Your withholding is subject to review by the IRS.

 

► Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the online estimator, and privacy.

Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Use the estimator at www.irs.govIW4App for most accurate withholding for this step (and Steps 3-4); or

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld

TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job.)

Step 3: Claim Dependents

If your income will be $200,000 or less ($400,000 or less if married filing jointly):

Step 4 (optional): Other Adjustments

Step 5: Sign Here

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

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional
tables; or, you can use the online withholding estimator at www.irs.govIW4App.

2. Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.

Limited Benefit & Self-Funded

Minimum Essential Coverage (MEC) Enrollment Guide

Complete the Enrollment Form to Elect or Decline Coverage

 

IMPORTANT PLAN INFORMATION: You have two medical plan options. You may enroll in one or both. Additional benefits are available to add if you enroll in the Fixed Indemnity Medical Plan.

1. You MUST complete the Enrollment Form as part of your New Hire Process.

2. Elect or decline all benefits on the Enrollment Form.

3. You MUST Sign and Date the bottom of the form, even if you decline coverage.

4. Return the Enrollment Form to your Branch Manager.

5. Keep the Benefits at a Glance page for your records.

 

Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

THE FIXED INDEMNITY MEDICAL PLAN IS A SUPPLEMENT TO HEALTH INSURANCE. IT IS NOT A SUBSTITUTE FOR ESSENTIAL HEALTH BENEFITS OR MINIMUM ESSENTIAL COVERAGE AS DEFINED UNDER THE AFFORDABLE CARE ACT (ACA).

The Essential StafFCARE Fixed Indemnity Medical, Prescription Drug, Accidental Loss of Life, Limb & Sight, Dental and Vision Plans are underwritten by BCS Insurance Company, Oakbrook Terrace, Illinois under Policy Series Numbers 25.1204, 26.1214, 26.212, and 26.213. The Term Life and Short-Term Disability Plans are underwritten by 4 Ever Life Insurance Company, Oakbrook Terrace, Illinois under Policy Series Number 62.200.

The MEC Wellness/Preventive Plan is an employer-sponsored, self-funded plan that has been deemed to be in compliance with ACA rules and regulations. More information about Preventive Services may be found on the government website at https://www.healthcare.gov/what-are-my-preventive-care-benefits/. For questions or assistance, please call Essential StaffCARE Customer Service at 1-866-798-0803.

 

Availability of Summary Health Information for MEC/Wellness Preventive Plan:

Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.

The SBC is available on the web at: essentialstaffcare.com/sbcmec. A paper copy is also available, free of charge, by calling Essential StaffCARE Customer Service 1-866-798-0803.

For questions or assistance, please call Essential StaffCARE Customer Service at 1-866-798-0803.

Essential StaffCARE

AIM ESC/MEC 4S P1DM v18.2

ENROLLMENT FORM

A. REQUIRED EMPLOYEE INFORMATION

PRINT USING BLACK or BLUE INK (Must Be Filled Out)

B. MEDICARE INFORMATION

C. LIMITED BENEFIT PLAN SELECTION

You MUST enroll in the Fixed Indemnity Medical Insurance Plan before adding any additional benefits in Section C. Your coverage level for the additional benefits in Section C will be identical to your fixed indemnity medical plan selection. This plan is underwritten by BCS Insurance Company

For Term Life / Accidental Loss of Life, Limb & Sight, please write in your beneficiary information. Accidental Loss of Life, Limb & Sight is part of the Fixed Indemnity Medical Benefit.

D. REQUIRED DEPENDENT INFORMATION

E. OPTIONAL MEC WELLNESS/PREVENTIVE BENEFIT SELECTION

Enrolling in the Optional MEC Wellness/Preventive Benefit may DISQUALIFY you from receiving a subsidy from the health insurance exchange. This plan satisfies the federal healthcare reform Individual Mandate. This is an offer of ACA compliant coverage and by purchasing this plan, you will not be taxed for failing to purchase insurance required by the Affordable Care Act. The MEC Wellness/Preventive Benefit is NOT underwritten by BCS Insurance Company. It is a benefit offered and provided by your employer. Rates for the MEC Wellness/Preventive Benefit are billed monthly.

F. REQUIRED SIGNATURE

I have read the Benefits Summary and the Limitations and Exclusions for the Fixed Indemnity Medical Plan. I understand that I have beer offered ACA compliant coverage (MEC Wellness/Preventive), and open enrollment is only available for a limited time. I understand that making no benefit selection is a declination of coverage.

5 PANEL

10 PANEL

Donor Consent: I certify that ( voluntarily consented to the collection and screening of any urine or salavla specimen, It is fresh and has not been adulterated in any manner. I certify that I provided my urine or salavia to the collector, and the specimen was screened in my presence.The information on this form is correct to the best of my knowledge.

Collector Certification: I certify that the specimen identified is the specimen presented to me by the donor proving the certificate.

Positive results will be confirmed by a drug-specified analysis at the employees;s expense

By entering this code the recruiter verifies that the applicant has fully completed part 1 of the application packet and has interviewed the applicant. The recruiter is willing to offer a position pending the completion of application part 2.

 

Offer of Position

 

PAYROLL DEDUCTION AGREEMENT

By signing this page, you are agreeing to the following processing fees that are required to start a position with MasterStaff, Inc. These processing fees include drug screen, background check, badge and lanyard. The full $20 will be deducted from your first paycheck regardless of the amount of hours worked.

TRICOM, INC.

Masterstaff Inc (1037)

Employee completes form and returns to Tricorn Funding

I hereby authorize Tricorn to initiate credit entries or such adjusting entries, either debit or credit which are necessary for corrections, to my account(s) indicated below and the depository(ies) named below to credit or debit) the same such account.**

MasterStaff, Inc. LOST PAYCARD ACKNOWLEDGEMENT FORM

I acknowledge that I will be issued a paycard through MasterStaff, Inc. Should I lose, misplace, or etc. my paycard, I acknowledge and agree that MasterStaff, Inc. will deduct $20.00 from my pay check for EACH replacement card that I have issued to me.

CONTINUED EMPLOYEE START-UP RECORD

BILLING INFORMATION

Federal: Please submit 2020 Form W-4 to your Tricorn Representative for processing

Alternate Information (Fill out if different from standard bill and rate info)

Federal: Please submit 2020 Form W-4 to your Tricorn Representative for processing

Alternate Information (Fill out if different from standard bill and rate info)