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.

It is Core Contracting, Inc's policy to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, physical or mental diability or veteran status.

This is to acknowledge that I have received a copy of the CORE Contracting, Inc. Employee Handbook. This Handbook sets forth the terms and conditions of my employment as well as the rights, duties, responsibilities and obligations of my employment with the Company. I understand and agree that it is my responsibility to read and familiarize myself with all of the provisions of the Handbook. I further understand and agree that I am bound by the provisions of the Handbook, particularly the provision relating to the mandatory, binding arbitration of any employment-related dispute. I understand that by agreeing to arbitration, I am waiving the right to a trial by jury of the matters covered by the "Arbitration Agreement". I understand that if I have any question about any portion of this Handbook, I may direct those questions to James Moore including the arbitration agreement.

WHETHER OR NOTIHAVE SIGNED ASEPARATE AGREEMENTTO ARBITRATE, I UNDERSTAND THAT MY EMPLOYMENT WITH THE COMPANY IS SUBJECT TO BINDING ARBITRATION, WHICH IS SET FORTH IN THE "ARBITRATION AGREEMENT". THIS AGREEMENT TO ARBITRATE CONSTITUTES A WAIVER OF ANY RIGHT THAT THE COMPANY OR I MAY HAVE TO BRING AND PURSUE ANY CLAIM IN A COURT OF LAW WITH A TRIAL BY JUDGE OR JURY. I UNDERSTAND AND ACKNOWLEDGE THAT THE AGREEMENT TO ARBITRATE CONTAINS A WAIVER OF MY ABILITY TO ACT AS A CLASS REPRESENTATIVE IN ANY CLASS ACTION PROCEEDING OR TO PARTICIPATE IN ANY CLASS PROCEEDING AS A MEMBER OF A CLASS. ARBITRATION PROVIDED FOR UNDER THIS AGREEMENT IS THE EXCLUSIVE METHOD TO RESOLVE ANY DISPUTES OR CONTROVERSIES THAT THE COMPANY OR I MAY HAVE, WHETHER OR NOT ARISING OUT OF MY EMPLOYMENT OR TERMINATION OF THAT EMPLOYMENT WITH THE COMPANY.

I understand the Company has the right to amend, modify, rescind, delete, supplement or add to the provisions of this Handbook, as it deems appropriate from time to time in its sole and absolute discretion except where prohibited by law. I further understand that my employment is at will and no manager, supervisor, or other employee of the Company, other than James Moore, can enter into an agreement for continued or indefinite employment or employment for a specific term, position, or rate of pay, and that any such agreement must be in writing signed by both me and James Moore.

My signature below certifies that I understand that the foregoing agreement on at will status is the sole and entire agreement between the Company and me concerning the duration of employment and the circumstances under which my employment may be terminated. It supersedes all prior agreements, understandings and representations concerning my employment with CORE Contracting, Inc.

Harassment in employment, including sexual, racial and ethnic harassment, because of race, color, religion, sex or gender, sexual orientation, gender identity or expression, pregnancy, marital status, national origin, citizenship, military and veteran status, ancestry, age (40 or over), physical or mental disability (an impairment that limits a major life activity), medical condition (cancer-related or genetic characteristic), genetic information as well as any other harassment forbidden by law, is strictly prohibited by the Company. Employees who violate this policy are subject to discipline, including possible termination.

• "Gender Expression" means a person’s gender-related appearance or behavior, whether or not stereotypically associated with the person’s sex at birth.
• "Gender identity" means a person’s identification as male, female, a gender different from the person’s sex at birth, or transgender.
• "Sex" includes, but is not limited to, pregnancy; childbirth; medical conditions related to pregnancy, childbirth, breastfeeding; gender identity; and gender expression.
• "Transgender" is a general term referring to a person whose gender identity differs from the person’s sex at birth. A transgender person may or may not have a gender expression different from social expectations of the sex assigned at birth. A transgender person may or may not identify as "trans sexual."

Forms of prohibited harassment include, but are not limited to:

• Visual conduct, including displaying of derogatory objects or pictures, cartoons, or posters; or
• Verbal conduct, including making or using derogatory comments, epithets, slurs, and jokes.

In addition, sexual harassment is defined by the regulations of the Fair Employment and Housing Commission as unwanted sexual advances, or visual, verbal or physical conduct of a sexual nature. Sexual harassment includes gender harassment and harassment on the basis of pregnancy, childbirth or related medical conditions, and also includes sexual harassment of an employee of the same gender as the harasser. This includes, but is not limited to, the following types of offensive behavior:

• Unwanted sexual advances;
• Offering employment benefits in exchange for sexual favors;
• Making or threatening reprisals after a negative response to sexual advances;
• Visual conduct, including leering, making sexual gestures, displaying of sexually suggestive objects or pictures, cartoons or posters;
• Verbal conduct, including making or using derogatory comments, epithets, slurs, and jokes;
• Verbal sexual advances or propositions;
• Verbal abuse of a sexual, racial or other prohibited nature, graphic verbal commentaries about an individual’s body, sexually degrading words used to describe an individual, suggestive or obscene letters, emails, texts, notes or invitations;
• Physical conduct, including touching, assault, impeding or blocking movements; and
• Using nicknames or terms of endearment with a racial, sexual or other prohibited connotation.

Examples of sexual harassment include (a) an employee being fired or denied a job or an employment benefit because the employee refused to grant sexual favors or because he or she complained about the harassment; (b) an employee reasonably quitting his or her job to escape harassment; or (c) an employee being exposed to a hostile work environment. Conduct need not be motivated by sexual desire to be considered sexual harassment.

Managers and supervisors are prohibited from providing favorable treatment to employees with whom they are involved in a consensual sexual relationship. Employees may also be personally liable for their own harassment.

Regardless of whether the action occurred on or off Company premises, if you believe that you have been discriminated against or you have been harassed by a co-worker, supervisor, agent, vendor or customer or other third parties or visitors; have witnessed possible discrimination and/or harassment; or if you believe that the Company or another employee has violated any applicable law in the conduct of the Company’s business, you have a duty to immediately bring the incident(s) to the attention of James Moore. If you do not feel that the matter can be discussed with your Supervisor, you should contact an Officer of the Company and arrange for a meeting. Any supervisory or managerial employee who receives such a complaint must promptly report it to James Moore. If you do not feel comfortable going to your Supervisor, you may also report your complaint of harassment to James Moore .

The description of the incident(s) can be given verbally or in writing.

The matter will be thoroughly investigated, with confidentiality maintained to the extent possible. We will track and document all steps in the investigation process. After reviewing the evidence, a determination will be made concerning whether reasonable grounds exist to believe that discrimination, harassment and/or a violation of law has occurred. It is the obligation of all employees to cooperate fully in the investigation process. The persons involved will be advised of the determination if appropriate.

The Company will take action to deter any future discrimination, harassment and/or violation of law. The Company considers any discrimination, harassment, and/or violation of law to be a serious offense which can result in disciplinary action for the offender, up to and including discharge. In addition, disciplinary action will be taken against any employee who attempts to discourage or prevent another employee from bringing discrimination, harassment and/or a violation of law to the attention of management.

The Company wants to assure all of its employees that measures will be undertaken to protect those who complain about discrimination, harassment and/or a violation of law from any coercion, intimidation, or retaliation due to their reporting an incident or participating in an investigation or proceeding concerning such an incident. The Company will provide appropriate options for remedial actions and resolution when warranted and will provide a prompt response to any complaint.

If any employee believes that the above procedure has not resolved a complaint of discrimination or harassment, that employee may contact the Federal Equal Employment Opportunity Commission or the California Department of Fair Employment and Housing who investigate and prosecute complaints of prohibited harassment, discrimination and retaliation in employment. If you think you have been harassed or discriminated against or that you have been retaliated against for resisting, complaining or participating in an investigation, you may file a complaint with the appropriate agency. The nearest office can be found by visiting the agency websites at www.dfeh.ca.gov for the Department of Fair Employment and Housing and www.eeoc.gov for the Equal Employment Opportunity Commission.

No action will be taken against any employee in any manner for filing a complaint with, or otherwise participating in an investigation, proceeding or hearing conducted by the DFEH or the EEOC with respect to discrimination or harassment.

Name and Address information for this form will populate from the Employee Application section. 

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

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

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

OR

OR

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

ALL DOCUMENTS MUST BE UNEXPIRED

Employees may present one selection from List A OR a combination of one selection from List B and one selection from List C.

LIST A

Documents that Establish Both Identity and Employment Authorization

 

1. U.S. Passport or U.S. Passport Card

2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa

4. Employment Authorization Document that contains a photograph (Form I-766)

5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status:

a. Foreign passport; and

b. Form I-94 or Form I-94A that has the following:

(1) The same name as the passport; and

(2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

 

LIST B

Documents that Establish Identity

 

1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

3. School ID card with a photograph

4. Voter's registration card

5. U.S. Military card or draft record

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner Card

8. Native American tribal document

9. Driver's license issued by a Canadian government authority

 

For persons under age 18 who are unable to present a document listed above:

 

10. School record or report card

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

 

LIST C

Documents that Establish Employment Authorization

 

1. A Social Security Account Number card, unless the card includes one of the following restrictions:

(1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION

2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)

3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

4. Native American tribal document

5. U.S. Citizen ID Card (Form I-197)

6. Identification Card for Use of Resident Citizen in the United States (Form I-179)

7. Employment authorization document issued by the Department of Homeland Security

 

Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

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.

-> 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.

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 estimator at www.irs.gov/W4App, and privacy.

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.gov/W4App for the most accurate withholding for this step (and Steps 3-4). If you or your spouse have self-employment income, use this option; or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; 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 generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate . . . . . . . . .

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):

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete. (This form is not valid unless you sign it)

This will certify that I have received a copy of the Company Employee Handout and agree to comply with the Company Safety Policy, Rules and Guidelines. The Safety Policy, Rules, and Guidelines have been reviewed and I understand that I will be subject to them during the course of my employment with CORE Contracting, Inc. I understand that a violation of the Safety Policy, Rules and Guidelines could endanger others or myself. I also understand that if I do not abide by these rules, I could be dismissed.

• I certify that I will not perform any task that is unsafe.
• I certify that I will receive training on any equipment or operation prior to starting the job task.
• I certify that I have received all Personal Protective Equipment required to complete my task.
• I certify that I have been trained on the chemicals at work and the location of the Material Safety Data Sheets.
• I certify that I have been trained on emergency procedures.
• I certify that in case I am injured while in the course of my work, I will report the injury to my Supervisor immediately and will obtain a Medical Treatment Authorization slip or verbal authorization from CORE Contracting, Inc. before reporting to a doctor for medical attention unless emergency services are contacted.
• I certify that I understand that the use of drugs and/or intoxicating beverages is prohibited and that I may be tested for drugs and/or alcohol if I am involved in an accident or incident at work that results in injury or property damage.
• I certify that I understand that CORE Contracting, Inc. reserves the right to review any previous injury.

My signature certifies that I have read and understand all (8) pages of this Employee Safety Policy and agree to abide by it.

The Workers' Compensation Anti-Fraud Bill took effect in 1992. This legislation should help to make the Workers' Compensation system more cost effective and to ensure that benefits go to workers with actual work related injuries or illness.

The Workers' Compensation Anti-Fraud Bill took effect in 1992. This legislation should help to make the Workers' Compensation system more cost effective and to ensure that benefits go to workers with actual work related injuries or illness.

 

This law includes:

• Felony criminal fraud is committed if anyone knowingly makes false statements to obtain or support a claim for benefits.
• Felony fraud convictions can be punishable by up to ten years in state prison and a fine of up to $150,000, or double the fraud, whichever is greater.
• Physicians and attorneys are prohibited from employing runners, cappers, or steerers to procure patients and clients.
• Using cappers to solicit claims is a misdemeanor, punishable by up to 5 years in jail and a fineof $10,000, or both.
• Qualified Medical Evaluators (QME) who are found guilty of using cappers can be fired, suspended or placed on probation.
• Insurers, self-insured employers and third-party administrators are required to report suspected fraudulent acts to their local district attorney or Bureau of Fraudulent Claims within 30 days of knowledge of fraud.
• The law prohibits print or broadcasting advertising services from printing or broadcasting any misleading, deceptive or false information about Workers' Compensation benefits.

 

By signing below, I attest that I have read and understand the California Anti-Fraud Bill.