Employment Documentation - Prime Facility Services Group

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.
Signature*

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Today's Date*

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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
Signature*

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Today's Date*

MonthDayYear

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.
Legal Names*

First NameMiddle InitialLast Name
Other Last Names Used (if any)
Address (Street Number and Name)*

Street Address

Apt. Number

City or TownState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
U.S. Social Security Number (SSN)*
Email*
Phone*
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)*

U.S. CitizenU.S. Noncitizen NationalLawful Permanent ResidentAlien Authorized to WorkForm I-94
Alien Registration Number/USCIS Number*
Alien Registration Number/USCIS Number**
Work authorization expiration date*

MonthDayYear
Permanent Resident Card expiration date*

MonthDayYear
Permanent Resident USCIS Number*
Foreign Passport Number*
Country of Issuance**
Country of Issuance*
Signature of Employee*

Clear
Today's Date*

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

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.

Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estate
Signature*

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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.
Signature*

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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:*

AcceptReject
Signature*

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Today's Date*

MonthDayYear
Should be Empty:

	YES	NO
Asthma
Diabetes
Allergies
Headaches
Back Injury
Bleeding Disorders
Fracture
Hepatitis A,B,C
Hernia
High Blood Pressure
Hypoglycemia
Pacemaker
Pregnancy
Smoking
Any Serious Problems, Surgery
Drug- Alcohol Abuse
Hypertension

Employment Onboarding

Pre- Employment Physical Form

W-9

8850

Non-Compete Clause