Jean Simpson New Customer (ABW)

CREDIT APPLICATION AND GUARANTY
CORPORATE NAME*
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TYPE OF BUSINESS:
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PLEASE GIVE THE NAME OF THE OWNERS, OFFICERS OR PARTNERS:

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COMPANY OWNER/OFFICER/PARTNER #1 FULL NAME*
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OWNER/OFFICER/PARTNER #1 HOME ADDRESS CITY, ST., ZIP
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OWNER/OFFICER/PARTNER #1 SOCIAL SECURITY #*
OWNER/OFFICER/PARTNER #1 DRIVER'S LICENSE OR STATE ID#*
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DATE OF BIRTH
COMPANY OWNER/OFFICER/PARTNER #2 FULL NAME
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Please provide information about any other businesses you own
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YES OR NO
If so, how many?
If yes - Where are the other locations?
How long have the present owners conducted this business?*
What are the principal lines of business?*
TRADE REFERENCES: Please list the NAME and COMPLETE MAILING ADDRESS
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IMPORTANT - PLEASE READ CAREFULLY

We hereby make application for credit. If credit is granted, we agree to pay all bills within the terms of the sale. We agree to pay a service charge of $15.00 for any checks returned from our bank unpaid, for any reason. We understand that a service charge may be assessed on any unpaid balance equal to the maximum allowed by law. Should legal action be taken to secure payment, we will be liable for all collection expenses, including collection agency fees and / or attorney fees at a rate of 33% and for all court costs. We agree not to transfer this agreement without the credit grantor's written consent. We further attest that the information provided herein is accurate and complete to the best of our/my knowledge. The information is given in confidence for the sole purpose of establishing credit.

AUTHORIZATION

Authorization is hereby given to make inquiry of all trade, banking and financial sources, including credit reports in accordance with the Fair Credit Reporting Act, which are deemed necessary by JEAN SIMPSON PERSONNEL SERVICES, INC. to propely evaluate this application.

PERSONAL GUARANTY

In consideration of the credit extension to the above applicant, the undersigned does hereby individually and personally guaranty to the credit grantor or their assigns the payment of such sums of money now and owing at any time due by this applicant to the credit grantor whether individually, or as a partnership or corporation.
NAME OF COMPANY*
Signature of Authorized Company Representative*

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Name and Title of Authorized Company Representative *
FULL NAME, TITLE
DATE*

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JEAN SIMPSON PERSONNEL SERVICES, INC.

POLICIES AND PROCEDURES

Thank you for contacting Jean Simpson Personnel Services, Inc. for your staffing needs!

We charge an hourly rate. This hourly bill rate for each employee covers paying the employee and all payroll costs (Social Security Tax, Medicare Tax, State & Federal Unemployment Tax, Workers’ Compensation, and Insurance). Overtime is applied after a 40-hour work week. Our work week runs Monday through Sunday.

Prior to beginning an assignment, all employees are furnished with timecards. All hours worked by the employees are logged in daily. At the end of each work week, all timecards must be verified and signed by the company and employee. Each employee is paid the following Wednesday. All companies are billed each Thursday with invoices due upon receipt.

We have a four (4) hour minimum per day, per employee. They are paid, and the employer is billed for four (4) hours per day, even if you only need them for two (2) or three (3) hours. (However, should they leave before the four (4) hours due to an emergency or their own choice, the four (4) hours per day, per employee minimum, will be waived.)

If you order an employee and upon their arrival decide they are no longer needed, you will be charged a two (2) hour show up time per employee.

If you choose to hire our employee immediately or before the required 480 hours, a liquidation fee will be charged in consideration of our advertising, recruiting, interviewing, and testing. After the employee has completed the required 480 hours on Jean Simpson Personnel Services, Inc. payroll, you may hire them with no liquidation fee due. Any hours worked over the required time (480 hours) will continue to be billed until you choose to hire the employee or their assignment ends.

If at any time you request the future services of a particular employee, please contact our office, and we will coordinate their return to you should they be available. Any applicant referred to you for any employment purposes is considered a Jean Simpson Personnel Services, Inc. applicant for 12 months from the date of referral. Should you hire that applicant within that 12-month period, you will be billed accordingly.

Due to the continued increase in our costs associated with the Affordable Care Act, there is a $.03 charge per hour per employee to your weekly invoice. This charge will show as a separate line item on the invoice.

Please contact us if you have any further questions at (318) 869-3494 for our Professional/Clerical Division and (318) 861-2489 for our Industrial Division. We will be happy to provide any additional information you need. Again, thank you for contacting Jean Simpson Personnel Services, Inc.
Agreed upon this day of *

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Signature of Authorized Company Representative*

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Name of Authorized Company Representative, and Title*
Full Name and Title

CONDITIONS OF SERVICE AND INDEMNIFICATION

In consideration for the furnishing of services by Jean Simpson Personnel Services, Inc., the Client hereby acknowledges, understands, and agrees to the following:

The Client shall pay invoices upon receipt and shall pay all reasonable attorneys' fees and other costs and expenses of collection incurred by Jean Simpson Personnel Services, Inc. in enforcing this agreement.

The Client shall not allow a Jean Simpson Personnel Services, Inc. employee to operate machinery or vehicles without prior consent from Jean Simpson Personnel Services, Inc. Jean Simpson Personnel Services, Inc.'s insurance will not cover physical loss or damage caused by a temporary employee's operation of Client's machinery or vehicles. The client will hold Jean Simpson Personnel Services, Inc., and its temporary employees, harmless from any loss or liability arising from the operation of the Client's machinery and vehicles. Client warrants that the Client complies with all occupational safety and health laws and regulations.

The Client shall not allow Jean Simpson Personnel Services, Inc. 's employees to handle cash, negotiable, or other valuables or be entrusted with otherwise unattended premises unless a specific exception to this provision is made by Jean Simpson Personnel Services, Inc. Under no circumstances will Jean Simpson Personnel Services, Inc. or its insurers be responsible for any claims of employee dishonesty or misconduct unless such claims are reported to Jean Simpson Personnel Services, Inc. within ten days of the occurrence, and the Client cooperates fully in the investigation and prosecution of such claims.

The Client agrees not to advance cash or valuables to a Jean Simpson Personnel Services, Inc. employee and waives any right that it might claim to offset or recoup any such advances made against any amount owed to Jean Simpson Personnel Services, Inc.
Signature of Authorized Company Representative

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Name of Authorized Company Representative and Title
Full Name and Title
Date*

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Date

PAYMASTER Service

Paymaster is a service Jean Simpson Personnel provides to our customers when they have already recruited an applicant and wish to screen them for employment, or as we refer to as a "working Interview." The applicant comes to our office, where we administer all the required tax forms, applications, and drug screening. They remain an employee of Jean Simpson for a minimum of 3 weeks (120 hours) which covers the initial hire cost involved in processing the application.

Jean Simpson Personnel Services, Inc. maintains the following:
- Payroll Records
- Social Security
- State & Federal Payroll Taxes
- Unemployment Taxes
- Workers' Compensation Insurance Requirements
- Affordable Health Care Insurance Coverage
Our work week is Monday through Sunday, and employees are paid weekly. "Direct Deposit" is provided for our employees. PAYMASTER checks can be picked up at our offices or mailed to the employee's residence. PAYMASTER Service also provides hourly cost savings from our regular rates due to our customer recruiting the applicant. Jean Simpson Personnel Services, Inc. is located in Louisiana and Texas. You may contact us as listed below.

1318 Shreveport-Barksdale Hwy, Shreveport, LA 71105 Clerical/Professional (318) 869-3494 Industrial (318) 861-2489

501 Spur 63, Suite C-4, Longview, TX 75601 (903) 758-7702

WORKPLACE INJURY POLICIES & PROCEDURES
Jean Simpson Personnel Services, Inc. is making great efforts to improve safety and reduce job-related injuries for our employees, and we need your help. It is extremely important that our employees are knowledgeable of YOUR safety policies. Wearing gloves, safety glasses, steel-toed boots, or any other required PPE is imperative. Please advise us immediately if any of our employees do not abide by your company safety policies.

INJURY PROCEDURES

Should an injury occur Monday-Friday between 8am and 4pm:

· Call Operations Manager, Gina Bihm IMMEDIATELY at our office 318.861.2489 or mobile 318.470.2963. If after 5:30 pm, your call will be directed to our on-call service. You will receive a call back from a Jean Simpson Personnel Services, Inc. associate.

· Take or send the employee to one of the following Willis-Knighton Work Kare Clinics (NOT the Emergency Room, unless after 7pm). Please use your professional discretion on calling 911.

Work Kare North - 2724 Greenwood Road, Shreveport, LA PH: 318-212-4750 FX:318-212-4545

Quick Care South (NO WORK KARE AVAILABLE) - 2520 Bert Kouns, Ste 105B, Shreveport, LA PH: 318-212-5520 FX: 318-212-5540

Work Kare Pierremont & Quick Care Location - 1666 E. Bert Kouns, Ste 125, Shreveport, LA PH: 318-212-3750 FX: 318-212-3755

Work Kare Bossier & Quick Care Location - 2300 Hospital Drive, Ste 360, Bossier City, LA PH: 318-752-7750 FX: 318-212-7756

Should an injury occur Monday-Friday between 4:00 pm and 7:00 pm

· Call Operations Manager, Gina Bihm IMMEDIATELY at our office 318.861.2489 or mobile 318.470.2963. If after 5:30 pm, our call will be directed to our on call service.

· Please refer employee to Willis-Knighton “Quick Care” clinics located at 1666 E. Bert Kouns or 2520 Bert Kouns in Shreveport or 2300 Hospital Drive in Bossier. Quick Care is open 7 days a week, 7am – 7pm.

Should injury occur Monday-Friday after 7pm or on a weekend:

· Call our office IMMEDIATELY 318.861.2489 to be directed to our on-call service.

· Take the employee immediately to any Willis-Knighton Emergency Room.

Should injury occur out of area:

· Call Operations Manager, Gina Bihm IMMEDIATELY at our office 318.861.2489 or mobile 318.470.2963. If after 5:30 pm, your call will be directed to our on-call service.

· Take the employee to the nearest medical facility.

*At the medical facility, please make sure the injured worker is identified as an employee of Jean Simpson Personnel Services, Inc. rather than an employee of your company. They will drug test an employee immediately following an injury.

We ask that all your shift supervisors be notified of these procedures. If you have any questions or require any assistance, please do not hesitate to call on us. – Gina Bihm, Operations Manager

Jean Simpson Personnel Services, 1318 Shreveport-Barksdale Hwy., Shreveport, LA 71105 318.861.2489

Revised April 2022
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PLEASE PROVIDE US WITH YOUR PRIMARY ACCOUNTS PAYABLE CONTACT

CREDIT APPLICATION AND GUARANTY

TYPE OF BUSINESS:

Please provide information about any other businesses you own

WORKPLACE INJURY POLICIES & PROCEDURES