TO BE COMPLETED BY THE BUSINESS OWNER

This Employment Enrollment Form is NOT an application for employment and should not be used as such.

(Informe de vinculación de empleados mediante arrendamiento Este Informe Laboral NO es una solicitud de trabajo y NO debe ser utilizado como tal

I hereby acknowledge my current employer (Client Company) has entered into an client services agreement contract with Workforce Business Services (WBS Through this contract WBS will provide Client Company with certain professional employer services. services. Under this arrangement Client Company and WBS will become co-employers. Under this co-employer relationship, I will be an assigned solely and exclusively to Client Company. I will remain an employee of Client Company and Client Company will continue to have control over my day-to-day job duties and the work site. Client Company will also continue to provide all on site supervision, including but not limited to, determining my job assignments and training requirements, evaluating my performance, and establishing pay rates. Client Company may have the right to accept or cancel the assignment. WBS will not have an on-site supervisor or representative at my work-site.

(Reconocimiento del arrendamiento de empleados Por la presente reconozco que he sido informado de que mi empleador actual (compañía cliente) ha entrado en un acuerdo con Servicios de Personal Empresariales (WBS sus iniciales A través de este contrato, WBS proporcionará a la compañía cliente ciertos servicios profesionales de empleadores. En virtud de este acuerdo la Compañía cliente y WBS se convertirán en Co-Empleadores. Bajo esta relación de Co-Empleadores, seré un empleado por arrendo de WBS, asignado únicamente y exclusivamente a la compañía cliente. WBS se reserva el derecho de dirección y control sobre los empleados arrendados asignados al lugar de trabajo de la compañía cliente. Continuaré siendo un empleado de la compañía cliente y la compañía cliente seguirá teniendo control sobre mis funciones de trabajo diarias y mi lugar de trabajo. La compañía cliente también continuará prestando toda la supervisión en el lugar de trabajo, incluyendo pero no limitándose a determinar la asignación de mi trabajo y los requisitos de entrenamiento, evaluación de mi desempeño y establecimiento de tasas salariales. WBS mantendrá la autoridad para contratar, terminar, disciplinar y reasignar a los empleados arrendados. Sin embargo, la compañía cliente puede tener el derecho de aceptar o cancelar la asignación. WBS no tendrá un supervisor o representante en mi lugar de trabajo.)

may be terminated at any time at the will of either WBS or myself, with or without cause, and without prior notice. The client services agreement between Client Company and WBS will not affect any agreement for employment or compensation which exists with my Client Company. If the contract between my Client Company and WBS is terminated, my work site employee status with WBS will also end on the date of the contract termination.

terminarse en cualquier momento por mi propia voluntad o la de WBS, con o sin causa y sin previo aviso. El acuerdo de arrendo de empleados entre la compañía cliente y WBS no afectará ningún acuerdo de empleo o compensación que existen con mi compañía cliente. Si el contrato entre mi compañía cliente y WBS se termina, mi calidad de empleado asignado al lugar de trabajo con WBS también terminará en la fecha de terminación del contrato

If WBS does not receive payment from my Client Company for services which I perform, WBS may then pay me the minimum wage or the legally required minimum salary or overtime pay for that period and I agree to this method of compensation. WBS assumes responsibility for the payment of such minimum wages to co-employees without regard to payments by Client Company to WBS. also agree that WBS does not assume responsibility for payment of any bonuses, commissions, severance pay, deferred compensation,

such items from Client Company. If the contract with my Client Company is terminated, my employment with WBS will end the date the contract terminates and WBS’s responsibilities as a co-employer shall also terminate at that time. WBS assumes full responsibility for payment of payroll taxes and collection of payroll taxes and collection of taxes from payroll on co-employees.

(Si WBS no recibe pago de mi compañía cliente por los servicios que preste, WBS me pagará el salario mínimo, o el salario mínimo legal, o pagará las horas extras de ese periodo y estoy de acuerdo con este método de compensación. WBS asume responsabilidad por el pago de salarios de empleados arrendados sin tener en cuenta los pagos efectuados por la compañía cliente a WBS. También estoy de acuerdo en que WBS no asume responsabilidad por pago alguno de bonos, comisiones, indemnizaciones por despido, compensación diferida, compartir utilidades, vacaciones, enfermedad u otro tiempo a pagar, o por cualquier otro pago, donde WBS no ha recibido el pago completo por adelantado para tales propósitos por la compañía cliente. Si se termina el contrato con mi compañía cliente, mi empleo con WBS terminará en la fecha que termina el contrato y las responsabilidades de WBS como Co-empleador también terminarán al mismo tiempo. WBS asume plena responsabilidad por el recaudo y pago de impuestos de nómina y por el recaudo de impuestos de nómina a empleados arrendados

agree to post-accident drug/alcohol testing for any work injury regardless of whether I am able to give consent at that time. This authorization or a photocopy hereof is my authority and consent to post-accident drug/alcohol testing in all instances.

(Prueba Antidrogas Estoy de acuerdo en cumplir con cualquier políticas de pruebas de drogas/alcohol cual Workforce Business Services

accidente de trabajo sin importar si puedo dar consentimiento en ese tiempo. Esta autorización o una fotocopia de esta autorización es mi autoridad y consentimiento para pruebas de drogas/alcohol en todos los casos

I authorize any physician, medical practitioner, hospital, clinic or other health facility, or employer, to release any and all medical and non-medical information in its possession about me to Workforce Business Services’ Workers’ Compensation carrier or its legal representatives for purposes of a workers’ compensation claim. (Medical information means all information in the posses sion of or derived from providers of health care regarding the medical history, mental or physical condition, or treatment of me I shall comply with the provisions of Florida Statute 440 concerning claims for workers’

and receive a copy of this authorization. A photocopy of this authorization shall be valid as the original.

(Acuerdo de Autorización medica para compensación del trabajador Nadie está obligado a proveer ninguna información médica hasta que una oferta de empleo se ha hecho y se ha aceptado. Yo autorizo a cualquier doctor, médico practicante, hospital, clínica u otra entidad de salud o empleador, para liberar toda la información médica y no médica en su posesión acerca de mí al portador del seguro de compensación a los trabajadores de Servicios de Personal Empresariales (WBS-por sus siglas en Ingles) o a sus representantes legales para

de los proveedores de atención de salud, relacionados con la historia médica, condición física o mental, o con mi tratamiento Cumpliré con las

recibir una copia de esta autorización. Una fotocopia de esta autorización será válida como la original

I agree to promptly and without delay report all accident, injuries, potential safety hazards, safety suggestions and health related issues to my manager.

orkforce Business Services that

I am being employed on an established 90 day probationary period

(Informe inmediatamente a su gerente todo accidente, lesion, peligros potenciales, sugerencias sobre seguridad y asuntos relacionados con la salud

I certify that I have read, understand, and agree to the conditions and requirements contained in this document, including my authorization for drug testing and for release of my medical and non-medical information. n.)

Date of Birth (Fecha de nacimiento):

Various agencies of the United States Government require employers to maintain information on applicants pertaining to factors such as race, sex and type of position for which an applicant applies. The information requested here is for compliance with certain record keeping requirements.

Varias entidades del gobierno de Estados Unidos exigen a los empleadores que mantengan información sobre los solicitantes en relación con factores como raza, sexo y tipo de cargo para el cual se presenta el candidato. La información que aquí se solicita es para cumplir con ciertos requisitos de registro.

White (Not of Hispanic or Latino origin) - Origins of Europe, North Africa, or the Middle East. Blanco (No de origen Hispánico ni Latino) – Originario de Europa, África del Norte o del Medio Oriente Hispanic or Latino - Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Hispano o Latino – Mexicano, Puertorriqueño, Cubano, Centro o Suramericano o de otra cultura u origen proveniente de España, independientemente de la raza

Black or African American (Not of Hispanic or Latino origin) - Origins in any of the Black racial groups of Africa. Negro o Afro-Americano (No de origen Hispánico ni Latino) Orígenes en cualquiera de los grupos raciales negros de África Asian (Not of Hispanic or Latino origin) - Origins of the Far East, Southeast Asia, the Indian Subcontinent Asiático (no de origen Hispánico ni Latino) – Originario del Lejano Oriente, Sudeste Asiático, o Subcontinente Indio

American Indian/Alaska Native - Origins of North or South America (including Central

Nativo de Alaska - Originario de América del Norte o del Sur (incluyendo América

Two or more races (Not of Hispanic or Latino origin) - All persons who identify with more than one of the listed races. Dos o más razas (No de origen Hispano ni Latino) – Todas las

If the employee elected not to complete this information, the employer has completed it

Completed by Client (Para ser diligenciado por el cliente)

New Hires (Nuevas Contrataciones)

You must fax, call or email the following information to WBS on or before the new hire starts work: name, WC Code, Social Security Number, Pay Rate and Date of Birth. Workforce Business Services can not pay any employee without receiving this information on or before the employee begins work. Nor will this employee be covered with

WBS tiene que recibir este Informe de Vinculación En la fecha de contratacion o antes. Usted puede informar esta nueva contratación a WBS por fax o por

empleado. El empleado tampoco quedará cubierto por la compensación de trabajadores hasta que esta información nos haya sido presentada. Para informar sobre alguna

THE EMPLOYEE ENROLLMENT FORM MUST BE RETURNED TO WBS WITHIN THREE DAYS OF THE DATE OF HIRE.

EL INFORME DE VINCULACIÓN DE EMPLEADOS MEDIANTE ARRENDAMIENTO DEBE SER ENVIADOA WBS

DENTRO DE LOS TRES DÍAS SIGUIENTES A LA FECHA DE CONTRATACIÓN.

In the event funds are deposited erroneously into my account, I authorize Workforce Business Services to debit my account(s) not to exceed the original amount of the credit. I understand that Wo rkforce Business Services reserves the right to refuse any direct deposit request. I also understand that all direct deposits are made through the Automated Clearing House (ACH), and that funds availability is subject to the terms and limitations of the ACH as well as my financial institution.

*NOTE* Initial set up of direct deposit may take 10 business days. You will receive a standard payroll check until this process has finalized. Workforce Business Services does not charge a fee for this service, however, your bank may. Please contact your bank directly with inquiries regarding additional fees.

Department of the Treasury Internal Revenue Service

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.

TIP: To be accurate, submit a 2021 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

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

Add the amounts above and enter the total here . . . . . . . . . . . . .

(a) Other income (not from jobs

If you want tax withheld for other income you expect

this year that won’t have withholding, enter the amount of other income here. This may

include interest, dividends, and retirement income .

(b) Deductions. If you expect to claim deductions other than the standard deduction

and want to reduce your withholding, use the Deductions Worksheet on page 3 and

enter the result here . . . . . . . . . . . . . . . . . . . . .

(c)Extra withholding. Enter any additional tax you want withheld each pay period .

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

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

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

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. If too little is withheld, you will generally owe tax when you file your tax return and may owe a penalty. If too much is withheld, you will generally be due a refund. Complete a new Form W-4 when changes to your personal or financial situation would change the entries on the form. For more information on withholding and when you must furnish a new Form W-4, see Pub. 505, Tax Withholding and Estimated Tax. Exemption from withholding. You may claim exemption from withholding for 2021 if you meet both of the following conditions: you had no federal income tax liability in 2020 and you expect to have no federal income tax liability in 2021. You had no federal income tax liability in 2020 if (1) your total tax on line 24 on your 2020 Form 1040 or 1040-SR is zero (or less than the sum of lines 27, 28, 29, and 30), or (2) you were not required to file a return because your income was below the filing threshold for your correct filing status. If you claim exemption, you will have no income tax withheld from your paycheck and may owe taxes and penalties when you file your 2021 tax return. To claim exemption from withholding, certify that you meet both of the conditions above by writing “Exempt” on Form W-4 in the space below Step 4(c Then, complete Steps 1(a), 1(b), and 5. Do not complete any other steps. You will need to submit a new Form W-4 by February 15, 2022. Your privacy. If you prefer to limit information provided in Steps 2 through 4, use the online estimator, which will also increase accuracy. As an alternative to the estimator: if you have concerns with Step 2(c), you may choose Step 2(b); if you have concerns with Step 4(a), you may enter an additional amount you want withheld per pay period in Step 4(c If this is the only job in your household, you may instead check the box in Step 2(c), which will increase your withholding and significantly reduce your paycheck (often by thousands of dollars over the year When to use the estimator. Consider using the estimator at www.irs.gov/W4App if you: 1. Expect to work only part of the year; 2. Have dividend or capital gain income, or are subject to additional taxes, such as Additional Medicare Tax; 3. Have self-employment income (see below); or 4. Prefer the most accurate withholding for multiple job situations. Self-employment. Generally, you will owe both income and self-employment taxes on any self-employment income you receive separate from the wages you receive as an employee. If you want to pay these taxes through withholding from your wages, use the estimator at www.irs.gov/W4App to figure the amount to have withheld. Nonresident alien. If you’re a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Check your anticipated filing status. This will determine the standard deduction and tax rates used to compute your withholding. Step 2. Use this step if you (1) have more than one job at the same time, or (2) are married filing jointly and you and your spouse both work. Option (a) most accurately calculates the additional tax you need to have withheld, while option (b) does so with a little less accuracy. If you (and your spouse) have a total of only two jobs, you may instead check the box in option (c). The box must also be checked on the Form W-4 for the other job. If the box is checked, the standard deduction and tax brackets will be cut in half for each job to calculate withholding. This option is roughly accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld, and this extra amount will be larger the greater the difference in pay is between the two jobs. Multiple jobs. Complete Steps 3 through 4(b) on only one Form W-4. Withholding will be most accurate if you do this on the Form W-4 for the highest paying job.

Step 3. This step provides instructions for determining the amount of the child tax credit and the credit for other dependents that you may be able to claim when you file your tax return. To qualify for the child tax credit, the child must be under age 17 as of December 31, must be your dependent who generally lives with you for more than half the year, and must have the required social security number. You may be able to claim a credit for other dependents for whom a child tax credit can’t be claimed, such as an older child or a qualifying relative. For additional eligibility requirements for these credits, see Pub. 972, Child Tax Credit and Credit for Other Dependents. You can also include other tax credits in this step, such as education tax credits and the foreign tax credit. To do so, add an estimate of the amount for the year to your credits for dependents and enter the total amount in Step 3. Including these credits will increase your paycheck and reduce the amount of any refund you may receive when you file your tax return.

Step 4(a Enter in this step the total of your other estimated income for the year, if any. You shouldn’t include income from any jobs or self-employment. If you complete Step 4(a), you likely won’t have to make estimated tax payments for that income. If you prefer to pay estimated tax rather than having tax on other income withheld from your paycheck, see Form 1040-ES, Estimated Tax for Individuals. Step 4(b Enter in this step the amount from the Deductions Worksheet, line 5, if you expect to claim deductions other than the basic standard deduction on your 2021 tax return and want to reduce your withholding to account for these deductions. This includes both itemized deductions and other deductions such as for student loan interest and IRAs. Step 4(c Enter in this step any additional tax you want withheld from your pay each pay period, including any amounts from the Multiple Jobs Worksheet, line 4. Entering an amount here will reduce your paycheck and will either increase your refund or reduce any amount of tax that you owe.

Step 2(b)—Multiple Jobs Worksheet (Keep for your records

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.gov/W4App.

Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one

job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the

“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter

that value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . .

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.

a Find the amount from the appropriate table on page 4 using the annual wages from the highest

paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job

in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries

and enter that value on line 2a . . . . . . . . . . . . . . . . . . . . . . .

b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the

wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower

Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

cAdd the amounts from lines 2a and 2b and enter the result on line 2c . . . . . . . . . .

Enter the number of pay periods per year for the highest paying job. For example, if that job pays

weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . .

Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld) . . . . . . . . . . . . . . . . . . . . . . . . .

Step 4(b)—Deductions Worksheet (Keep for your records

Enter an estimate of your 2021 itemized deductions (from Schedule A (Form 1040

may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to

$10,000), and medical expenses in excess of 10% of your income . . . . . . . . . . . .

. . . . . . . .

If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater

. . . . . . . . . . . . . . . . . . . . . . . . . .

Enter an estimate of your student loan interest, deductible IRA contributions, and certain other

adjustments (from Part II of Schedule 1 (Form 1040

See Pub. 505 for more information

Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 . . . . . . . . . . .

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person with no other entries on the form; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

$100,000 - $110,000 - 109,999120,000

$0 - 9,999 $10,000 - 19,999 $20,000 - 29,999

$30,000 - 39,999 $40,000 - 49,999 $50,000 - 59,999

$60,000 - 69,999 $70,000 - 79,999 $80,000 - 99,999

$100,000 - 149,999 $150,000 - 239,999 $240,000 - 259,999

$260,000 - 279,999 $280,000 - 299,999 $300,000 - 319,999

$320,000 - 364,999 $365,000 - 524,999 $525,000 and over

$100,000 - $110,000 - 109,999120,000

$0 - 9,999 $10,000 - 19,999 $20,000 - 29,999

$30,000 - 39,999 $40,000 - 59,999 $60,000 - 79,999

$80,000 - 99,999 $100,000 - 124,999 $125,000 - 149,999

$150,000 - 174,999 $175,000 - 199,999 $200,000 - 249,999

$250,000 - 399,999 $400,000 - 449,999 $450,000 and over

$100,000 - $110,000 - 109,999120,000

$0 - 9,999 $10,000 - 19,999 $20,000 - 29,999

$30,000 - 39,999 $40,000 - 59,999 $60,000 - 79,999

$80,000 - 99,999 $100,000 - 124,999 $125,000 - 149,999

$150,000 - 174,999 $175,000 - 199,999 $200,000 - 249,999

$250,000 - 349,999 $350,000 - 449,999 $450,000 and over

I hereby authorize Workforce Business Services to deduct said amount(s) above from my paycheck, of an

. In the event my employment with said named client is

terminated for any reason, I authorize the total remaining balance due be deducted from my final paycheck(s) in accordance with Federal and State laws.

WBS is committed to the safety and health of all employees and recognizes the need to comply with regulations governing injury and accident prevention and employee safety. Maintaining a safe work environment, however, requires the continuous cooperation of all employees. WBS está comprometida con la seguridad y la salud de todos sus empleados y reconoce la necesidad de cumplir las regulaciones que rigen la prevención de lesiones y accidentes y la seguridad de los empleados. El mantenimiento de un ambiente de trabajo seguro requiere, sin embargo, la cooperación permanente de todos los empleados.

1. Promptly and without delay report all accident, injuries, potential safety hazards, safety suggestions and health related issues to your manager. (Informe inmediatamente a su gerente todo accidente, lesión, peligros potenciales, sugerencias sobre seguridad y asuntos relacionados con la salud 2. No alcohol, controlled substances or non-prescribed medication will be used on the job at any time. (Nunca ingiera alcohol, sustancias controladas o medicamentos no prescritos durante el trabajo 3. Use the correct method of lifting objects. Lift with your legs, not your back. If a load is too heavy or awkward, ask for assistance. (Use los métodos correctos para levantar objetos. Levántelos subiendo sus piernas, no su espalda. Si una carga es demasiado pesada o incómoda de levantar, pida ayuda 4. If you are not sure how to do a job, stop and check with your supervisor. (Si no está seguro sobre cómo se realiza un trabajo, deténgase y estúdielo con su supervisor 5. Do not start or operate any equipment without the proper authority and safety instruction. (No comience a operar un equipo sin la debida autorización e información de seguridad 6. Report malfunctioning equipment to your supervisor immediately. (Reporte inmediatamente a su supervisor los equipos que estén funcionando mal 7. Any employee who is furnished safety equipment will be required to use such equipment. (Todo empleado que reciba equipo de seguridad tiene la obligación de usar dicho equipo 8. Good housekeeping practices should be followed at all times. (Siga siempre las buenas prácticas de orden 9. All electrical power tools and cords must have an operational third wire positive ground. (Todas las herramientas y cables deben tener polo a tierra) 10.

procedimientos 11. If available, seat belts must be worn at all times in vehicles and machinery. (Si los vehículos y maquinaria tienen cinturón de seguridad, es obligatorio usarlo siempre 12.

13. Obey all safety and warning signs at all times. (Obedezca siempre todas las señales de seguridad y advertencia 14. Submitting false or fraudulent information when reporting an injury is a felony. (Presentar información falsa o fraudulenta al reportar una lesión es un delito grave 15. Job safety is the responsibility of each individual employee. (La seguridad en el trabajo es responsabilidad de cada empleado individual