Employee Application

Construction Trades Staffing Inc.

Employee Application
Date*
xx/xx/xxxx format
Social Security Number*
Wage (if known)
Last Name
First Name
Middle Initial
Address
Phone
City
State/Province
Postal/Zip Code
Cell
Emergency Contact
Emergency Contact Phone
Company
Pay Rate

Employee Agreements and Acknowledgements
Drug Screening:
I authorize and give full permission to have Construction Trades Staffing Inc., and/or a company designated physician send a specimen of my urine and/or blood to a lab for screening tests for the presence of illegal drugs, alcohol, or prescription medication taken without a prescription. I will hold all parties harmless, meaning I will not sue nor hold responsible for any alleged harm to me, or for interfering with my obtaining a job or continuing employment and not submitting to the test or as a result of the report of the test. This includes, but is not limited to, possible clerical or lab error. This policy and authorization is written in a language that I understand and I agree to adhere to the Construction Trades Staffing Inc. "Substance Abuse Policy". I understand and agree that a post accident drug screen will be required.
Signature

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Date*
xx/xx/xxxx format
Driver's License Record Release/Criminal Record Release:
I give Construction Trades Staffing Inc. permission to verify any/all records re: my NYS Drivers License. I give Construction Trades Staffing Inc. permission to obtain any/all criminal records and/or conviction files anywhere in the United States.
I give Construction Trades Staffing Inc. express consent to release this information to their customers as it pertains directly to me being placed for work with that customer. In doing so I understand that I am waiving my right to confidentiality concerning my criminal, driving and past employment record
Signature

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Date*
xx/xx/xxxx format
Medical Authorization:
In the event of an on-the-job injury, I authorize full access to copies of medical records, radiology reports, drug/alcohol screenings, and documents of any kind relating to my past or present injury or illness to Construction Trades Staffing Inc. I hereby agree to release this information and hold all such medical providers harmless from the release of this information as set forth here.
Signature

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Date*
xx/xx/xxxx format
Job Safety:
I agree to report any unsafe working conditions to my job foreman and/or supervisor and Construction Trades Staffing Inc. I agree to wear any and all protective safety equipment given to me by my job foreman and/or supervisor and/or as required for and by my job duties.
Signature

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Date*
xx/xx/xxxx format
Handbook:
Furthermore, by signing below, the above named individual verifies they have received a copy of Construction Trades Staffing Inc. Employee Handbook & the Safety Checklist, and has read, fully understands and agrees to adhere to those policies and procedures incorporated therein and made part of this application.
Signature

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Date*
xx/xx/xxxx format

Reliability Policy
As a Construction Trades Staffing employee are you are the face of our company. While working for our clients you must be the sole representative of our company.

While we strive to place each individual on a job, it is not always possible. When you "NO CALL, NO SHOW', you are not only poorly representing out company, you are putting our clients in a tough position, and taking away a potential job from another associate who would have shown up to work.

As long as you remain dependable and professional we will give you as many opportunities as we can find. We will not utilize our resources on associates who have let us down, hurt our clients, and take jobs away from other employees who want to work.

Associates who "NO CALL, NO SHOW" will be terminated from our company and will not be eligible for another position through Construction Trades Staffing Inc.
Associates Name
Associates Signature

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Date*
xx/xx/xxxx format

New York State Department of Labor

Notice and Acknowledgement of Pay and Payday for Hourly Rate Employees
Employee's rate(s) of pay:
$ TBD per TBD
$ TBD per TBD
$ TBD per TBD
Allowances taken:   Please select 'none'
   None   *
Regular Payday is Friday
Pay*

Weekly
Overtime Pay Rate: TBD -

$ TBD per hour (This must be at least 1 ½ times the workers' regular rate with few exceptions.)
Notice given:*

At hiring
Employee Acknowledgement:
On this day, I received notice of my pay rate, overtime rate (if eligible), allowances and designated payday. I told my employer what my true primary language is.
Check one:

I accepted this pay notice in English, because it is my primary language.I accepted this pay notice in English because the Department of Labor does not yet offer pay notice form in this language on its website
If you checked the second box, please write the name of your primary language below:
Employee Name
Employee Signature

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The employee must receive a copy of this signed form. The employer must keep the original for 6 years.

Construction Trades Staffing Inc.

Direct Deposit Form
Employee Name
Effective date after 1 week processing
Bank Account Information
Primary Account
Account Type*

CheckingSavings
Name of Bank
% Amount:
$ Amount:
Routing Number:
Account Number:
Secondary Account
Account Type

CheckingSavings
Name of Bank
% Amount:
$ Amount:
Routing Number:
Account Number:
I, blanks hereby authorize Construction Trades Staffing Inc. to initiate credit entries and if necessary, debit entries and any adjustments to credit entries into the accounts indicated above. This authority is to remain in full force and effect until otherwise noted in a written manner and at a reasonable amount of time to make the necessary changes. I also acknowledge that direct deposit is not guaranteed and will take no less than 10 days from my next check date to begin.
Signature: Direct Deposit Form

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*To ensure complete accuracy, please provide a voided copy of a blank check

Employee's Withholding Certificate

Form W-4
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.
Step 1: Enter Personal Information
(a) First name and middle initial
Last name
Address
City or town, state, and 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
(b) Social security number
(c)

Single or Married filing separatelyMarried filing jointly or Qualifying widowerHead 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.
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 4c 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 .

D
TIP: To be accurate, submit a 2023 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3-4(b} on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job
Step 3: Claim Dependents
If your 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:
Step 4: Other Adjustments

(Optional)
4(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(b) Deductions:
If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deduction Worksheet on page 3 and enter the result here.
4(c) Extra withholding:
Enter any additional tax you want withheld each pay period.
Step 5: Sign Here

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

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Date*

MonthDayYear
Date
Employers Only
Employer's name and address

CONSTRUCTION TRADES STAFFING INC
3959 N. BUFFALO RD
ORCHARD PARK, NY 14127
First date of employment

MonthDayYear
Date
Employer identification number (EIN)

27-0492627

Step 2(b)-Multiple Jobs Worksheet

(Keep for your records)
If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
1. Two jobs. If you have two jobs or you're married filing jointly and you and your spouse each have one job, find the amount from the appropriate table on page 4. Using the "Higher Paying Job" row and the "Lower Paying Job" column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3.
1. $ blanks
2. Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.
a) Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the "Higher Paying Job" row and the annual wages for your next highest paying job in the "Lower Paying Job" column. Find the value at the intersection of the two household salaries and enter that value on line 2a
2a. $blanks
b) Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the "Higher Paying Job" row and use the annual wages for your third job in the "Lower Paying Job" column to find the amount from the appropriate table on page 4 and enter this amount on line 2b
2b. $blanks
c) Add the amounts from lines 2a and 2b and enter the result on line 2c
2c. $blanks
3. Enter the number of pay periods per year for the highest paying job. For example, if that job pays weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc.
3. $blanks
4. Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld)
4. $blanks
Step 4(b)-Deductions Worksheet

(Keep for your records.)
1. Enter an estimate of your 2023 itemized deductions (from Schedule A (Form 1040)). Such deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 7.5% of your income
1. $blanks
2. Enter:
- $25,100 if you're married filing jointly or qualifying widow(er)
- $18,800 if you're head of household
- $12,550 if you're single or married filing separately
2. $blanks
3. If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater than line 1, enter "-0-"
3. $blanks
4. Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information
4. $blanks
5. Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4
5. $blanks
Privacy Act and Paperwork Reduction Act Notice. We ask for the Information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(ij(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a proper1y completed form will result in your being treated as a single person with no other entries on the form; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

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

Employment Eligibility Verification

Department of Homeland Security: USCIS Form I-9
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form 1-9 no later than the first day of employment, but not before accepting a job offer.)
Last Name (Family 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*
xx/xx/xxxx format
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):
Type a question

1. A citizen of the United States2. A noncitizen national of the United Slates (See instructions)3. A lawful permanent residen4. An alien authorized to work
(Alien Registration Number/USCIS Number):
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)
Aliens authorized to work must provide only one of the following document numbers to complete Form l-9:

An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign Passport Number.
1. Alien Registration Number/USCIS Number:
OR
2. Form 1-94 Admission Number:
OR
3. Foreign Passport Number
3. Country of Issuance:
Signature

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Today's Date (mm/dd/yyyy)
Preparer and/or Translator Certification (check one):

I did not use a preparer or translator.A preparer(s) and/or transialor(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.
Signature

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Today's Date (mm/dd/yyyy)
xx/xx/xxxx format
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code
NOTE: Employer Completes Next Page

Construction Trades Staffing Inc.

Work Experience

4: Excellent / 3: Very Good / 2: Good / 1: Some Experience

Finish Carpenter: Exp Rating

Plumber: Exp Rating

Electrician: Exp Rating

Commercial Carpenter: Exp Rating

Concrete/Masonry: Exp Rating

Painter (List Type if Possible): Exp Rating

Plasterer: Exp Rating

Laborer

Other

Work Experience: Continued

Past Employers

Employee Agreements and Acknowledgements

Reliability Policy

New York State Department of Labor

Construction Trades Staffing Inc.

Bank Account Information

Primary Account

Secondary Account

*To ensure complete accuracy, please provide a voided copy of a blank check

Employee's Withholding Certificate

Step 1: Enter Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependents

Step 4: Other Adjustments

Step 5: Sign Here

Employers Only

Step 2(b)-Multiple Jobs Worksheet

Step 4(b)-Deductions Worksheet

Employment Eligibility Verification

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.

NOTE: Employer Completes Next Page

Employment Eligibility Verification

Employee Info from Section 1

List A: Identity and Employment Authorization

OR

List B: Identity

AND

List C: Employment Authorization

Employee's Withholding Allowance Certificate

Complete the worksheet on the next page before making any entries.

Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.

I certify that I am entitled to the number of withholding allowances claimed on this certificate.