SENCO CONSTRUCTION

SENCO CONSTRUCTION
OPERATORS, LABORERS, CARPENTER & PIPEFITTERS MUST COMPLETE A UNION FORM
PIPEFITTERS MUST COMPLETE 401K DEDUCTION FORM
Complete the following for your employee file (Please Print):
FIRST NAME *
LAST NAME *
CELL PHONE # *
BIRTHDATE *

Month Day Year
Date
OK TO TEXT YOU: *

YES NO
NO
DRIVER'S LIC # *
*EXP. DATE *

Month Day Year
Date
ALTERNATE PHONE#
EMERGENCY CONTACT
SOCIAL SECURITY # *
EMERGENCY PHONE #
OSHA 10 HOUR
LOCAL UNION #
HAZWOPER EXP
CRANE CERT EXP
FORKLIFT EXP
Notify Timekeeping and Payroll of new employee;Delivercompleted packet to HR
EMPLOYEE #
CRAFT CODE
Copy of Driver's License
Copy of SS Card
MPC ORIENTATION DATE

Month Day Year
Date
SENCO DRUG TEST DATE

Month Day Year
Date
DISA TEST DATE

Month Day Year
Date
DISA HAIR TEST DATE

Month Day Year
Date
BACKGROUND CHECK DATE

Month Day Year
Date
TWIC EXPIRE

Employee's Withholding Certificate

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.
First name and middle initial *
Last name *
Social security number *
Address *
City or town *
State *
Zip Code *
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.
*

Single or Married filing separately Married filing jointly or Qualifying widow(er) Head of household Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual
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.
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.gov/W4App 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 2022 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 Steps3-4(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):
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500
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 4(a)
(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 4(b)
(c) Extra withholding. Enter any additional tax you want withheld each pay period 4(c)
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee's signature (This form is not valid unless you sign it.) *

Clear
Date

Month Day Year
Date
Employer's name and address
First date of employment

Month Day Year
Date
Employer identification number (EIN)

Illinois Withholding Allowance Worksheet

Use this worksheet as a guide to figure your total withholding allowances you may enter on your Form IL-W-4. Complete Step 1. Complete Step 2 if you (or your spouse) are age 65 or older or legally blind, or you wrote an amount on Line 4 of the Deductions Worksheet for federal Form W-4.

If you have more than one job or your spouse works, your withholding usually will be more accurate if you claim all of your allowances on the Form IL-W-4 for the highest-paying job and claim zero on all of your other IL-W-4 forms. You may reduce the number of allowances or request that your employer withhold an additional amount from your pay, which may help avoid having too little tax withheld.

Step 1: Figure your basic personal allowances (including allowances for dependents)
Check all that apply

No one else can claim me as a dependent. I can claim my spouse as a dependent.
1 Enter the total number of boxes you checked.
2 Enter the number of dependents (other than you or your spouse) you will claim on your tax return.
3 Add Lines 1 and 2. Enter the result. This is the total number of basic personal allowances to which you are entitled. You are not required to claim these allowances. The number of basic personal allowances that you choose to claim will determine how much money is withheld from your pay. See Line 4 for more information. 3
4 Enter the total number of basic personal allowances you choose to claim on this line and Line 1 of Form IL W 4 below. This number may not exceed the amount on Line 3 above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay.
Step 2: Figure your additional allowances
Check all that apply

I am 65 or older. I am legally blind. My spouse is 65 or older. My spouse is legally blind.
5 Enter the total number of boxes you checked.
6 Enter any amount that you reported on Line 4 of the Deductions Worksheet for federal Form W 4 plus any additional Illinois subtractions or deductions.
7 Divide Line 6 by 1,000. Round to the nearest whole number. Enter the result on Line 7.
8 Add Lines 5 and 7. Enter the result. This is the total number of additional allowances to which you are entitled. You are not required to claim these allowances. The number of additional allowances that you choose to claim will determine how much money is withheld from your pay.
9 Enter the total number of additional allowances you elect to claim on Line 2 of Form IL W 4, below. This number may not exceed the amount on Line 8 above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld deducted from your pay. IMPORTANT: If you want to have additional amounts withheld from your pay, you may enter a dollar amount on Line 3 of Form IL W4 The below amount will be deducted from your pay in addition to the amounts that are withheld as a result of the allowances you have selected.
Form IL-W-4 below. This number may not exceed the amount on Line 3 above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay.
Cut here and give the certificate to your employer. Keep the top portion for your records.

Illinois Department of Revenue

IL-W-4 Employee's Illinois Withholding Allowance Certificate
1 Enter the total number of basic allowances that you are claiming (Step 1, Line 4, of the worksheet).
Social Security number *
First Name *
Last Name *
Street address *
2 Enter the total number of additional allowances that you are claiming (Step 2, Line 9, of the worksheet).
City *
State *
ZIP *
3 Enter the additional amount you want withheld (deducted) from each pay.
I certify that I am entitled to the number of withholding allowances claimed on this certificate.
Your signature *

Clear
Date *

Month Day Year
Date

Printed by the authority of the State of Illinois PO Number: 2200208 500 copies

This form is authorized under the Illinois Income Tax Act. Disclosure of this information is required. Failure to provide information may result in this form not being processed and may result in a penalty.

Employer: Keep this certificate with your records. If you have referred the employee's federal certificate to the IRS and the IRS has notified you to disregard it, you may also be required to disregard this certificate. Even if you are not required to refer the employee's federal certificateto the IRS, you still may be required to refer this certificate to the Illinois Department of Revenue for inspection. See Illinois Income Tax Regulations 86 III. Adm. Code 100.7110.
DEPARTMENT
Employment Eligibility Verification Department of Homeland Security
USCIS
U.S. Citizenship and Immigration Services
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.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 nolater than the first day of employment, but not before accepting a job offer
Last Name (Family Name) *
First Name *
Middle Initial
Other Last Name(s)
Name

First Name (Given Name) Middle Initial Other Last Names Used (if any)
Address (Street Number and Name) *
Apt. Number
City or Town *
State *
ZIP Code *
Date of Birth (mm/dd/yyyy) *

Month Day Year
Date
U.S. Social Security Number *
Employee's E mail Address
example@example.com
Employee's Telephone Number
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)

1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number/USCIS Number): 4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):
Some aliens may write "N/A" in the expiration date field. (See instructions)authorized to work until (expiration date, if applicable, mm/dd/yyyy)

Month Day Year
Date
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.

QR Code Section 1 Do Not Write In This Space
1. Alien Registration Number/USCIS Number
2. Form I 94 Admission Number
3. Foreign Passport Number
Country of Issuance
Signature of Employee *

Clear
Today's Date (mm/dd/yyyy) *

Month Day Year
Date
Preparer and/or Translator Certification (check one)

I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(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.

SENCO CONSTRUCTION

DIRECT DEPOSIT AUTHORIZATION
I hereby voluntarily authorize SENCO Construction Inc to direct deposit my pay check into my account(s) at the financial institution(s) named below.

Further, I agree not to hold SENCO Construction Inc responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until SENCO Construction Inc receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.
Last Name
First Name
Social Security Number
Authorized Signature

Clear
Date

Month Day Year
Date
START Direct Deposit CHANGE Direct Deposit STOP Direct Deposit
Bank Name
Bank Routing Number
Account Number
Enter Dollar Amount or % of Net Pay or Balance of Pay
Account Type (Select One)

Checking Savings Christmas Club
VOID
Anytown Bank Anytown, MI 48888
Anytown Bank
For
I: 072412345
I

SENCO CONSTRUCTION

New Employee Indoctrination
The purpose of this indoctrination is to inform new employees of the basic safety rules and regulations they must follow. Employees must understand what safety equipment they will be required to use, and how to utilize it properly. Specialized training and equipment may also be required, depending on the scope of the work the employee will be performing.

In addition to the basic safety rules and regulations, there are additional policies specific to SENCO Construction Inc. that must be read and understood prior to beginning work with the company. this includes teh SENCO Construction Inc. "Disciplinary Policy" and the SENCO Construction Inc. "Anti-Harassment Policy."

You must first read the contents of this "New Employee Indoctrination" packet. After reading and understanding the contents, you will be required to provide your signature and the date which you signed. Failure to provide your signature will result in ineligibility to work for SENCO Construction Inc. Employee questions are encouraged in order to provide new employees with as much useful information as possible. It is your responsibility to report any unsafe acts or conditions to your supervisor or the safety department.

Please Note
- It is required that SENCO have a copy of your social security card and a form of photo ID (driver's license) on file within 3 days of employment. This is only for the purposes of MVR and background checks.
- You must have a valid driver's license or work permit on file to drive a SENCO vehicle.
- H2S monitor, company provided FR, radio and any keys must be returned prior to layoff or termination.
- Operators must complete daily checklist for equipment used.
- PTHAs and Work Clearance Permits must be obtained prior to work being performed.
- If you lose your scan card, it will cost you $10 to replace it.
You may NOT have any of the following items in your possession or in your vehicle while it is on SENCO or Marathon property:
- Guns, with or without ammunition (loaded or empty cartridges) without proper paperwork from MPC/SENCO
- Bows, with or without arrows
- Knives 4" or larger Personal pocket knives that do not lock in the open position
- Drugs or drug paraphernalia
- Alcohol containers (open or empty)
Personal Protective Equipment

The following personal protective equipment (PPE) will be required while performing work for SENCO:
- Hard hat
- Safety glasses (Z87)
- Safety boots or shoes (Z41-1991) specifications (provided by the employee)
- Chemical splash goggles
- Fire Retardant (FR 2122) coveralls/clothing must be worn while working in the MPC refinery, pipeline, or terminal
  - Shirts must be tucked in, coveralls zipped, and sleeves rolled down at all times
  - Any company provided FR garments will be laundered and/or replaced by SENCO if they become torn, worn, oil soaked, etc.
- Hearing protection when working in required areas or operating equipment that produces noise levels above 85dB
- ANSI 4 or greater cut resistant work gloves
- Personal Hydrogen Sulfide (H2S) monitors, when working in areas of the MPC Refinery which require them to be worn
- Employees may be required to use specialized safety equipment including respiratory protection, nitrile gloves, rubber boots, fall protection, etc. This equipment will be provided for on-the-job use at no cost to the employee.
Hazard Communication

As an employee, you have the right to know what chemicals and hazards exist in your work area. Youshould be familiar with the HAZCOM standard. A list of all hazardous chemicals and SDSs are available to you at your request. A copy of the SENCO Construction Inc. Hazard Communications Program is available to you at any time. You must be aware of the physical and health hazards associated with hazardous chemicals in your work environment, and the measures and PPE available to you to protect yourself from these hazards. You must also be able to read and understand an SDS. Employees must also have an understanding of container and hazardous chemical labeling.
Disciplinary Policy

SENCO Construction, Inc. has developed this disciplinary policy as a means of addressing employee safety infractions. Communication between Management, Supervision, Safety, and all employees is critical to ensure that employees understand the safety policies and procedures they are expected to observe. When supervision or safety must address an employee's infraction, the following guidelines will be used to ensure effective communication has taken place with the affected employee(s)
1. Management, Supervision or Safety must identify the infraction, and collect as much accurate information as possible concerning the incident or infraction before the employee is confronted.
2. When the employee(s) is (are) confronted, Management, Supervision or Safety must establish a true cause for the infraction.
3. Both parties must be open to practical solutions
4. Establish corrective measures to address the issue, or initiate disciplinary action for the employee(s)
Disciplinary Action

If it is determined that the employee has intentionally violated a known safety policy or procedure, or has performed an act that could potentially cause harm to himself, herself, or another employee, that employee will be subject to the following disciplinary action:
1. The first infraction will result in a minimum of a verbal warning. The infraction will be documented and noted in the employee's file. Depending on the seriousness of the infraction, a first infraction may result in dismissal from work.
2. The second infraction will result in a minimum of a written warning. The written warning will be documented in the employee's file. A second infraction may also result in suspension from work. The duration of the suspension will be determined by SENCO Management and may result in dismissal from work.
3. The third infraction will result in dismissal. This will be documented and placed in the employee's file. The employee will be placed on a status of "Not for Rehire" with SENCO. Information concerning the dismissal will not be made available to other employees.
** Willful safety violations in which an employee demonstrates disregard for the safety of any person, including himself/herself, or other employees, which could result in personal injury or result in property damage, will not be tolerated, and may result in immediate termination from work.

The following will be regarded as safety infractions, and will be treated as such:
- Horseplay
- Failure to follow written and/or verbal safety procedures
- Failure to wear or misuse of personal protective equipment
- Failure to cooperate with Management, Supervisor, or Safety personnel concerning safety issues Intentional disregard for safety issues
- Intential disregard for safety
Company Comittment

It shall be the responsibility of SENCO Management, Supervision and Safety Department to ensure that all employees are observing company safety policies and program guidelines. Also, SENCO Management, Supervision and Safety Department must perform physical inspections of the work area(s Any employee lack of commitment to safety, or any safety violations observed, will be regarded as a serious violation, and will result in employee disciplinary action.

Management and Supervision must be held to the same accountability as all other employees. Any SENCO employee has the right and responsibility to inform Management or Supervisor personnel of any safety violations that they (Management or Supervisors) may be committing. All employees must practice safe work procedures in order to achieve our safety goals.

Equal Employment Oppurtunity

SENCO Construction, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Anti-Harassment Policy

Everyone deserves to work in an environment that is pleasant, professional, and free of intimidation or hostility - be it verbal, physical, or visual. Any form of unwelcomed behavior - whether harassment or not - is unacceptable at SENCO.

Sexual harassment is defined as unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature when this conduct explicitly or implicitly affects an individual's employment, unreasonably interferes with an individual's work performance, or creates an intimidating, hostile, or offensive work environment.

Harassment isn't always sexual in nature, and it's not always direct. It can include offensive language, statements, jokes, cartoons, pictures, signs, posters, emails, pranks, intimidation, physical contact, violence, threatening phone calls, or derogatory remarks - even if they are not directed to the targeted individual. If it makes you feel uncomfortable, it should be addressed. SENCO also prohibits any retaliation against an employee who has discussed or made a harassment complaint.

If you or a co-worker have been the subject of any form of harassment, immediately report the conduct to your supervisor or to Management. Once the company is informed, we will take prompt and appropriate action to investigate the incident. No retaliatory action will be taken against you if your report is made in good faith. A worker determined to exhibit behavior contributing to harassment of anyone in the workplace will be subject to disciplinary action, including termination, with or without notice.
Weapons

SENCO Construction complies fully with all applicable federal, state and local laws to include the Concealed Carry Act. Firearms of any type are strictly prohibited within company premises at all times. Company premises includes the SENCO Main Office, Safety Annex, Fabrication Shop, Maintenance Shop and all parking lots excluding the gravel lot south of the SENCO Training Center. Company premises also include anywhere that company business is conducted, such as customer locations, vendor/associate locations, trade shows, restaurants or any venue visited for the purpose of business.

Regardless of whether an employee possesses a concealed carry permit or is allowed by law to possess a firearm, firearms are prohibited on all company premises, except the south parking lot.

Please note: Firearms and weapons, including those used for hunting or fishing, are only permitted inside of personal vehicles located in SENCO's South parking lot and only with the approval of company Management.
Searches

SENCO reserves the right to perform searches of employees, customers, vendors, and vehicles entering, leaving, or parking on SENCO property for illegal drugs, paraphernalia, weapons, and stolen property. SENCO also reserves the right to search any employee's office desk, files, lockers, computers, and office files on our premises. These items are the property of SENCO. Inspections may be conducted at anytime at the discretion of SENCO.

Compliance with Marathon Petroleum Policies

SENCO employees working for SENCO on Marathon Petroleum Company premises are subject to all MPC policies and SPs. These SPs are available to you, from MPC or SENCO, should you wish to review them at any time. Some policies of interest may include, but are not limited to:
- Drug and Alcohol Policy
- Safety and Security Policies
- Weapons Policy
- Anti-harassment Policy
- Smoking Policy
There is enhanced focus on Life Critical Safety Rules including:
- Safe Work Permit
- Fall Protection
- Confined Space Entry
- Alky Unit PPE
- Electrical Safe Work Practices
- Energy Isolation
- Hot Work
- Bypass Safety Devices
- Hoisting and Lifting
Violations of Life Critical Safety Rules may result in permanent removal from MPC and/or SENCO.

Additional details regarding MPC Policies will be provided during Safety Orientation.
Employment

It is the policy of SENCO Construction Inc. that all employees are employed at the will of the company. Employees may resign from the company at any time for any reason and may be terminated by the company at any time for any reason, with or without notice.

Work and Pay Schedule

You will be informed of your work schedule when you report to work for SENCO Construction Inc. The pay period begins on Monday and concludes on Sunday. You will receive your check the following Wednesday for the previous week's work.

Grievances

All employee grievances should be reported to SENCO Supervision. Employee complaints will be addressed by management in a confidential manner. Reporting grievances will not result in any form of retaliation.

Safety Meetings

You will be required to attend a weekly safety meeting conducted by the SENCO Safety Department. In addition to the weekly meeting, you are expected to participate in a daily tool-box meeting with your immediate work group as well as SENCO Construction's daily stretching program. This will be conducted by the job foreman at the beginning of each shift.

By signing below, you acknowledge that you have read and understand all policies and procedures provided to you in the SENCO Construction Inc. New Employee Indoctrination, and that failure to comply with these policies will result in disciplinary action or possible termination.
Employee Signature *

Clear
Date *

Month Day Year
Date

SENCO CONSTRUCTION, INC
DRUG-FREE WORKPLACE POLICY
First Name *
Last Name *
1. I understand and agree that I may receive a complete copy of the Employee Name SENCO CONSTRUCTION INC. DRUG-FREE WORKPLACE POLICY upon my request understand the information outlined, have asked any questions I may have concerning its contents and will comply with all policies and procedures to the best of my ability.
2. Further, I accept, agree, and consent to the provisions of this policy as terms of employment. I understand I am going to be requested to take and successfully pass drug and alcohol test as a condition of employment.
3. I give my full consent to the release of all drug and alcohol test results to the authorized Medical Review Officer, who will forward the results to SENCO CONSTRUCTION INC. Designated Employee Representative.
I understand that access to information obtained under this policy is limited to those who have a legitimate need to know in compliance with relevant laws and management policies. SENCO may use information obtained under this Policy to support, explain, or defend any employment decision or action taken with regard to that employee including, but not limited, defending against any claim for unemployment benefits by the employee.

I understand that my failure to honor all the terms of this certificate is ground for immediate termination of my employment.

The statements contained in the SENCO CONSTRUCTION INC. DRUG-FREE WORKPLACE POLICY are intended to serve as general information concerning SENCO CONSTRUCTION INC. and its existing policies, procedures, and practices.

Nothing contained in the SENCO CONSTRUCTION INC. DRUG-FREE WORKPLACE POLICY is intended to create, nor shall be construed as creating, an expressed or implied contract of employment or guarantee of employment for the definite or indefinite terms.

From time to time SENCO CONTRUCTION INC. may need to clarify, amend, and/or supplement the information contained in the Drug and Alcohol Policy. The company will inform me of these changes.

I understand that I will not be compensated for any time, including show up time, for any time awaiting laboratory drug testing results following a positive or invalid instant test that results in a confirmed positive test by the MRO.
Employee Signature *

Clear
Date *

Month Day Year
Date
Social Security Number *
First Name *
Last Name *
Witness Signature

Clear
Date

Month Day Year
Date
Printed Name Witness Signature Please list Authorized Substances prescribed by your physician:
Prescription Name(s)
Prescribed Dates (Additional room on back of page)

Month Day Year
Date

GRADING MATRIX-CRITERIA

Summary:

The following grading matrix criteria represents a selection of specific conviction types for federal, felony and misdemeanor convictions. Each of the two following lists will be used to assign numeric values to each “graded” criminal report. The “graded” matrix criteria will be applied against the county/parish, federal and Patriot Act searches for the Graded Package 2.0. This includes of all qualifying federal, misdemeanors and felony conviction types.

If Statement	Record Information	Then
No record is found,		Grade will be sent as a "CLEAR."
The record is a conviction beyond seven years (based upon the disposition date).	Delete all record information	Grade will be sent as a "CLEAR."
The record is a non-conviction (except for adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined).	Delete all record information	Grade will be sent as a "CLEAR."
The charge type is Misdemeanor and is NOT one of the following Misdemeanors where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.	Leave the record information "as is."	Grade will be sent as "Hit- 01"
The charge type is one of the following Misdemeanors where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.	Leave the record information "as is."	Grade will be sent as "Hit- 02"
The charge type is Federal or Felony and is NOT one of the following Federal or Felonies where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.	Leave the record information "as is."	Grade will be sent as a "Hit- 03"
The charge type is Federal or Felony and is NOT one of the following Federal or Felonies AND the charge type is one of the Misdemeanors listed below where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.	Leave the record information "as is."	Grade will be sent as a "Hit- 04"
The charge type is one of the following Federal or Felonies where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.	Leave the record information "as is."	Grade will be sent as "Hit- 05"
The charge type is one of the following Federal or Felonies AND the charge type is one of the following Misdemeanors where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.	Leave the record information "as is."	Grade will be sent as a "Hit- 06"
Reporting if the applicant is subject to various economic-sanctioned programs administered by the Office of Foreign Assets Control, such as specially designated nationals, terrorists, narcotics traffickers, and blocked persons and vessels.	Leave the record information “as-is”	Grade will be sent as a "Hit- 07"

COUNTY CRIMINAL MISDEMEANOR CONVICTIONS

The following list represents a selected list of misdemeanor conviction types to be used for the purposes of assigning a numeric “graded” value. The Qualified Vendor will review all qualifying misdemeanor conviction types and apply the appropriate “graded” value based on the specific conviction type.

Assault
Battery
Bodily Injury
Cruelty to a Juvenile
Deadly Conduct
Disorderly Conduct
Disorderly Person
Escape
Harassment
Resisting arrest
Resisting Public Officer
Robbery
Terrorist Threats
Throwing a deadly missile
Violation of restraining order
Weapon

COUNTY CRIMINAL FELONY or FEDERAL CONVICTIONS

A crime involving a severe transportation security incident (i.e. Security incident involving a significant loss of life, environmental damage, transportation system disruption, or economic disruption in a particular area
Aiding others in terrorism
Aircraft piracy outside the special aircraft jurisdiction of the United States, 49 U.S.C. 46502(b)* aircraft piracy, 49 U.S.C. 46502*
Arson
Assault (including aggravated and or sexual)
Bribery
Burglary (breaking and entering)

Carjacking
Carrying a weapon or explosive aboard aircraft, 49 U.S.C. 46505*

Commission of certain crimes aboard aircraft in flight, 49 U.S.C. 46506*
Computer crimes (hacking, fraud, damage to property)
Conveying false information and threats, 49. U.S.C. 46507*
Credit card fraud
Criminal anarchy
Denied or removed under the Immigration And Nationality Act (8 U.S.C. 1182 Et Seq)*
Destruction of an aircraft or aircraft facility, 18 U.S.C. 32*
Drug offenses
Embezzlement
Espionage
Explosive offenses (devices, fake explosive devices, incendiary devices, dangerous articles, importation, manufacture, distribution, storage)
Extortion
False imprisonment - armed or hostage taking
False personating (peace office, public official)
Forgery and counterfeiting
Fraud (including dishonesty and misrepresentation)
Homicide / murder / manslaughter / including solicitation to murder (excluding negligent manslaughter)
Identify theft
Immigration violations
Improper transportation of a hazardous material, 49 U.S.C. 46312*
Interference with air navigation, 49 U.S.C. 46308*
Interference with flight crew members or flight attendants, 49 U.S.C. 46504*
Kidnapping
Lighting violations involving transporting controlled substances, 49 U.S.C. 46315*
Misprision of treason
Monetary instrument abuse
Perjury and false swearing
Purse snatching
Racketeering and RICO violations
Rape
Robbery
Sedition
Sex crimes
Smuggling
Tax evasion
Terrorism
Theft-larceny (including felony shoplifting)
Treason
Unlawful entry into an aircraft or airport area that serves air carriers or foreign air carriers contrary to established security requirements, 49 U.S.C. 46314*
Weapons (any offense-carrying a concealed weapon, weapon on premises, illegal use, manufacture, store, sell,distribute, discharge, etc.)
Traffic offenses i.e., traffic homicide, hit and run (excluding dwi/dui convictions)

*United States Code is offered as a reference to the nature of the crime. Similar state laws are also considered disqualifying.

Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

· You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.

· You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

o a person has taken adverse action against you because of information in your credit report;

o you are the victim of identity theft and place a fraud alert in your file;

o your file contains inaccurate information as a result of fraud;

o you are on public assistance;

o you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.

· You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

· Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

· Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

· Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

· You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

· You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address form the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).

· The following FCRA right applies with respect to nationwide consumer reporting agencies:

Consumers Have the Right To Obtain a Security Freeze

You have a right to place a “security freeze” on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent. However, you should be aware that using a security freeze to take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any other account involving the extension of credit.

As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer’s credit file. Upon seeing a fraud alert display on a consumer’s credit file, a business is required to take steps to verify the consumer’s identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years.

A security freeze does not apply to a person or entity, or its affiliates, or collection
agencies acting on behalf of the person or entity, with which you have an existing
account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account
maintenance, monitoring, credit line increases, and account upgrades and enhancements.

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS	CONTACT:
1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFB:	Consumer Financial Protection Bureau 1700 G Street, N.W. Washington, DC 20552 b. Federal Trade Commission Consumer Response Center 600 Pennsylvania Avenue, N.W. Washington, DC 20580 (877) 382-4357
2. To the extent not included in item 1 above: a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act. c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions	a. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX 77010-9050 b. Federal Reserve Consumer Help Center P.O. Box 1200 Minneapolis, MN 55480 c. FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO 64106 d. National Credit Union Administration Office of Consumer Financial Protection (OCFP) Division of Consumer Compliance Policy and Outreach 1775 Duke Street Alexandria, VA 22314
3. Air carriers	Asst. General Counsel for Aviation Enforcement & Proceedings Aviation Consumer Protection Division Department of Transportation 1200 New Jersey Avenue, S.E. Washington, DC 20590
4. Creditors Subject to the Surface Transportation Board	Office of Proceedings, Surface Transportation Board Department of Transportation 395 E Street, S.W. Washington, DC 20423
5. Creditors Subject to the Packers and Stockyards Act, 1921	Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies	Associate Deputy Administrator for Capital Access United States Small Business Administration 409 Third Street, S.W., Suite 8200 Washington, DC 20416
7. Brokers and Dealers	Securities and Exchange Commission 100 F Street, N.E. Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations	Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above	Federal Trade Commission Consumer Response Center 600 Pennsylvania Avenue, N.W. Washington, DC 20580 (877) 382-4357

SENCO CONSTRUCTION, INC

DRIVER'S PRIVACY PROTECTION ACT

DISCLOSURE AND EXPRESS CONSENT

In connection with your application for employment, application to serve as a contractor, or in connection with your continued employment or continued service as a contractor with SENCO Construction, Inc. (“SENCO”), you understand that SENCO may request information regarding you and your motor vehicle record from the state department of motor vehicles, or similar state agency (e.g. Illinois Secretary of State), which issued you your current drivers license. You understand that your motor vehicle record may include information that identifies you, including your photograph, social security number, driver identification number, name, address, telephone number, medical or disability information, and driving record (“Motor Vehicle Record”). You understand that SENCO has contracted with S2Verify of Roswell (Atlanta) Georgia to obtain your Motor Vehicle Record.

By signing below you hereby authorize SENCO directly, and through S2Verify, to obtain your Motor Vehicle Record from the state agency which issued you your current drivers license. You hereby authorize and request, without any reservation, that the state agency which issued you your current drivers license to furnish to SENCO and S2Verify your Motor Vehicle Record. You understand and agree that SENCO may use your Motor Vehicle Record for employment purposes.
Signature *

Clear
First Name *
Last Name *
Date of Birth (mm/dd/yyyy) *

Month Day Year
Date
Date *

Month Day Year
Date

AUTHORIZATION FOR SAFETY COUNCIL OF TEXAS CITY

TO PROCESS MY SOCIAL SECURITY NUMBER FOR VERIFICATION

I hereby acknowledge and agree that the Safety Council of Texas City (herein referred to as SCTC) has a legitimate business need to verify my identity before I can be issued a Council badge which indicates, by virtue of its existence, that my identity has been verified. I understand that by providing authorization to SCTC and partner consumer reporting agencies, to process a verification of my Social Security Number, I shall not be issued a badge from SCTC if the verification process fails to identify me as the proper holder of the Social Security Number I submit below.

I authorize and instruct SCTC and partner consumer reporting agencies, to verify my identity through consumer reports and social security number information and I am providing this as my written instruction and authorization to SCTC and partner consumer reporting agencies to verify my identity through consumer reports and social security number information. I understand that I have the right to request of partner consumer reporting agencies, upon proper identification and the payment of any legally permissible fees, for the information in its files on me at the time of the request.

By my signature at the bottom of this form, I authorize my employer to submit this form on my behalf to the Safety Council so that my verification can proceed as if I was at the Safety Council signing this authorization.
First Name *
Middle Initial
Last Name *
Address (Street Number and Name) *
City or Town *
State *
ZIP Code *
Date of Birth (mm/dd/yyyy) *

Month Day Year
Date
U.S. Social Security Number *
Driver's License State *
Driver's License Number *
Expiration Date *
Race *
Birth Date *

Month Day Year
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Gender *
Other or Former Names
Other Forms of Identification
Signature *

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Date *

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Date
First Name *
Middle Initial *
Last Name *
Should be Empty:

SENCO CONSTRUCTION

OPERATORS, LABORERS, CARPENTER & PIPEFITTERS MUST COMPLETE A UNION FORM

PIPEFITTERS MUST COMPLETE 401K DEDUCTION FORM

DEPARTMENT

USCIS

SENCO CONSTRUCTION

VOID

I: 072412345

SENCO CONSTRUCTION

SENCO CONSTRUCTION, INC

DRUG-FREE WORKPLACE POLICY