Employment Documentation - Prime Facility Services Group
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  • Employment Onboarding

    Prime Facility Services Group, Inc

  • Welcome to the Digital Employment Documentation Form from Prime Facility Services Group, thanks for taking the time to fill it out.

    Verify that all the information included in this form is true, correct, complete, legal and of your complete knowledge.

    The red star represents a required field. *

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  • STEP 1
    Enter Personal Information

  • Remember to use only your full legal names as they appear on your ID card (Social Security Card).
    No Nicknames or pseudonyms. This in order to issue and deliver checks to the correct person and avoid mistakes.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth*
     / /
  • Are you citizen of the United States?*
  • Are you authorized to work in the United States?*
  • Have you ever been convicted of a felony?*
  • Do you count with a motor vehicle for transportation?*


  • References

  • Format: (000) 000-0000.
  • Positions you have experience or skill at:*
  • Positions you are interest in:*


  • Previous Employment

  • Format: (000) 000-0000.
  • Date of Start
     / /
  • Date of Ending
     - -


  • Documents

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  • Acceptable photo format

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  • Disclaimer

  • I, certify that the aforementioned information is true to the best of my knowledge. If I am hired, I understand that false or misleading information in my application
    or interview may result in termination

  • I, certify that the aforementioned information is true to the best of my knowledge. If I am hired, I understand that false or misleading information in my application
    or interview may result in termination

  • Today's Date*
     / /

  • Criminal Release Authorization and Staff Wages Agreement

    Notification and Authorization to Release Information for Employment Purposes

    The position for which I am being considered requires me to consent to a criminal background check as a condition of employment. I hereby authorize Prime Facility Services Group, Inc. to conduct the criminal background check. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist Prime Facility Services Group, Inc. in collecting this information. First Verify has been secured as a third party vendor (consumer reporting agency) to assist Prime Facility Services Group, Inc. in collecting and verifying information.

    I am also aware that records of arrests on pending charges and/or convictions are not an absolute bar to employment. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner, which is safe for Prime Facility Services Group, Inc. employees, customers, and vendors.

    By signing below, I am authorizing my background information to be released to Prime Facility Services Group, Inc.

  • Today's Date*
     / /

  • Staff Wages Agreement

    1. Give a week’s notice before quitting job
    2. Not walk out mid shift
    3. Not leave during training days
    4. Not leave in the first week
    5. Schedule time off/vacation a week in advance with Prime
    6. Not be fired in the first week of work
    7. The final check must be picked up in person at the main office located at 8303 Westglen Dr,Houston, Texas 77063
  • Today's Date*
     / /

  • Equal Employment Opportunity Form
    Voluntary Information

    The information being requested is in accordance with Federal Regulations. It is voluntary and will not be used when considering you for employment with our company.

  • Racial or Ethnic Group
  • Gender
  • Military Service
  • How did you hear about this position?

  • Pre- Employment Physical Form 

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • *
  • Latex Allergies:*

  • *Inch

  • *

  • Have you had any falls this past year, If yes how many?*
  • Have you received previous treatment for this condition? If yes, date*
  • Have you ever had surgery? If yes, Explain;*
  • Are you taking medication? If yes, Explain;*
  • Have you ever had any of the following?*
  • Rows
  • Format: (000) 000-0000.
  • Are you currently under a doctor's care? If yes, for what problem?*

  •                            
           

  • I hereby certify that all of the above answers are true to the best of my knowledge.

    I authorize the release of this medical record to my employer or prospective employer.

  • Date*
     - -

  • USCIS Form I-9
    Employment Eligibility Verification

    Department of Homeland Security U.S. Citizenship and Immigration Services


    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. Click here for the instructions.

    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.

  • Date of Birth*
     / /
  • Format: (000) 000-0000.

  • 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)*
  • Work authorization expiration date*
     / /
  • Permanent Resident Card expiration date*
     / /
  • Today's Date*
     / /

  • List of Acceptable Documents can be found in the link here.

  • W-4 FORM
    Employee’s Withholding Certificate

  • General Instructions
    Future Developments
    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.

    Purpose of Form
    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.

    Exemption from withholding. You may claim exemption from withholding for 2020 if you meet both of the following conditions: you had no federal income tax liability in 2019 and you expect to have no federal income tax liability in 2020. You had no federal income tax liability in 2019 if (1) your total tax on line 16 on your 2019 Form 1040 or 1040-SR is zero (or less than the sum of lines 18a, 18b, and 18c), 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 2020 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 16, 2021.

    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 the 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.

  • Step 1
    Enter Personal Information

  • Marital Status*

  • Step 2
    Multiple Jobs or Spouse

  • You hold more than one job at a time, or are married filing jointly and your spouse also works*

  • Step 3
    Claim Dependents

  • Will you make less than $200,000 USD this year ($400,000 or less if married filing together):*

  • Step 4 (optional)
    Other adjustments

  • I have another adjustments to make

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

  • Today's Date*
     / /

  • W-9

    Request for Taxpayer Identification Number and Certification
  • Check appropriate box for federal tax classification of the person whose name is entered. Check only one of the following boxes.

  • 8850

    Pre-Screening Notice and Certification Request for the Work Opportunity Credit
  • Check here if you received a conditional certification from the state workforce agency (SWA) or a participating local agency for the work opportunity credit.*
  • Check here if any of the following statements apply to you.• I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9months during the past 18 months.• I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (foodstamps) 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; orb. 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 thepast year*
  • Check here if you are a veteran and you were unemployed for a period or periods totaling at least 6 months during the past year*
  • Check here if you are a veteran entitled to compensation for a service-connected disability and you were discharged or released from active duty in the U.S. Armed Forces during the past year.*
  • Check here if you are a veteran entitled to compensation for a service-connected disability and you were unemployed for a period or periods totaling at least 6 months during the past year.*
  • Check here if you are a member of a family that:• 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*
  • Check here if you are in a period of unemployment that is at least 27 consecutive weeks and for all or part of that period you received unemployment compensation.*

  • Non-Compete Clause

  • Throughout the duration of this Agreement the Recipient shall not, in any manner, represent, provide services or engage in any aspects of business that would be deemed similar in nature to the business of Prime Facility Services Group, Inc. without its written consent, to any of its current clients and/or customers.

    The Recipient warrants and guarantees that throughout the duration of this Agreement and for a period of 12 months following the culmination, completion or termination of its work cycle, that Recipient shall not directly or indirectly engage in any business that would be considered similar in nature to the business engaged in by Prime Facility Services Group, Inc., with any current clients and/or customers.

  •  

    Prime Facility Services Group, Inc. is pleased to announce that we are now offering Medical Insurance through SBMA for our employees, in compliance with the Affordable Care Act.

    Effective Date: August 1, 2025

    Eligibility: Variable employees are eligible after completing one year of full-time employment.

    Benefits (summary):

    Office Visits: $15 co-pay for in-network doctors / $50 co-pay for specialists
    Deductible: $1,500 per employee / $3,000 per family

    Prescription Drugs:

    $10 co-pay for generic drugs
    Discount only for approved name-brand drugs
    Discount only for non-approved name-brand drugs
    Out-of-Pocket Limit: $9,100 per employee annually / $10,000 per family annually
    Weekly Employee Cost: $50

  • Please indicate below if you will accept or reject the coverage:*
  • Today's Date*
     / /
  • Should be Empty: