Greer's Green Thumb Lawn Care Employee Registration

Registration

Please complete the following to the best of your ability .
Your Contact Information
Full Legal Name
Exactly as it appears on your drivers license or ID
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone Number
E-mail
Emergency Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relationship
Banking Information

If you wish for your wage to be paid to you via direct deposit, fill out this section; if this section does not apply to you, check “I do not wish to enroll in direct deposit” at the end.
Bank Name
Routing Number
Account Number
Check this box only if you do not have a bank account and can not accept your wage via direct deposit. Cash payments will be charged 10% of their gross wage to account for the time that is required for management to go to the bank.

I do not wish to enroll in direct deposit.
I understand that by selecting the box above, that I am opting out of direct deposit payments. I wish to receive my wage in cash installments. I will receive a 10% reduction from the gross wage owed to me.
Signature

Clear
Other Information
Include any information that should be known by management here. The includes: other skills, allergens, schedule conflicts, important information, funny jokes that management need to be made laugh at, or any other information not previously asked that could be found valuable to your employment.
I hereby affirm that all information provided above is accurate to the best of my knowledge and belief, and I understand that this information will be considered material in the evaluation of any and all decisions regarding my employement.
Date

MonthDayYear
Date
Employee Signature

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Louisiana Office of Motor Vehicles

Louisiana Official Driving Record
Before you will be allowed to operate a company vehicle, an official louisiana driving record will be obtained on your behalf. Your driving record will be printed and placed into your file for as long you are employed by Greer's Green Thumb Lawn Care, LLC. Your information will be shared with our insurance company only for purposes associated to perform a risk assessment of your motor vehicle operatioh by the insurance conpany. Your record will be kept as historical documentation for 7 years following the last day of your emplyement by Greer's Green Thumb Lawn Care, LLC. If you, at any time during your emplyement, would like to obtain a printed version of this document, please contacg management in perrson or by phone respectively.

INFORMATION PROVIDED BY YOUR OFFICIAL DRIVING RECORD INCLUDES:
- Accident Statement - Accodent involvement indicated does not mean the individual was at fault or given a citation.
- Personal Status - Indicates status of individual's personal driving privellages.
- CDL Status - Indicates the status of an individual's commercial driving privillages if he/she has a commercial driver's license.
- Offenses on Record - Includes all on-line data such as tickets/accidents.
INFORMATION THAT WILL BE USED TO OBTAIN YOUR DRIVING RECORD
- Name
- Address
- Driver's license number
- Date of birth
- Class of license
DISCLAIMER

This will be a document that will hold personal information that is protected uner federal law. In accordance with the US Code, Title 18, #2721 through #2725 and Section 350 of Public Law 106-69 which amended the Federal Driver Privacy Protection Act OLA File No. 1999-1126.

PROCUREMENT FOR UNLAWFUL PURPOSE

It is unlawful for any person knowingly to obtain or disclose personal informatin, from an individual's motor vehicle rechord.

CRIMINAL AND/OR PENALTIES

A person who knowingly violates the Federal Driver Privacy Protection Act shall be fined $2500.00 in damages to the person whose record was improperly released.

CIVIL ACTION

A person who knowingly obtains, discloses or usews personal information, from a motor vehicle record, for purpose permited under the Federal Driver Privacy Protection Act shall be liable to the individual to whom the information pertains, who may bring a civil action in a United States district court.

RESALE AND RE-DISCLOSURE

A person obtaining Motor Vehicle recrod information for any permiteed use who resells or re-discloses the information must maintain record on any entity or person that received the information and the permitted use of which it was obtained for a period of not less than 5 years. These records must be available to the Officew of Motor Vehicles, upon request.
Personal Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drivers License Number
Birth Date

MonthDayYear
Class of License
Authorization of Document Request
I hereby authorize Greer's Green Thumb Lawn Care, LLC or any management level employee of Greer's Green Thumb Lawn Care, LLC acting soley on the behalf of Greer's Green Thumb Lawn Care, LLC to use the information provided above to obtain a Louisiana Official Driving Record on my behalf. I understand that this is an official record containing private information. I understand that this information will be used to assess my risk as the operator of a motor vehicle. I understand that a judgement based soley upon this risk assessment will be made to weather or not I may continue on in my emploeyemnt with Greer's Green Thumb Lawen Care, LLC. I understand that my official louisiana driving record can be requested by Greer's Green Thumb Lawn Care, LLC during any time deemed approriate by Greer's Green Thumb Lawn Care, LLC as long as I am employeed by Greer's Green Thumb Lawn Care, LLC.
Signature

Clear
Date

MonthDayYear
Date
Authorization of Re-Disclosure
I hereby authorize Greer's Green Thumb lawn Care, LLC to re-disclose any and all information found within my official louisiana driving record with the provider of their motor vehicle insurance policy for the purposes of risk assessent and inclusion of motor vehicle insurance policy during any time deemed approriate by Greer's Green Thumb Lawn Care, LLC as long as I am employeed by Greer's Green Thumb Lawn Care, LLC.
Signature

Clear
Date

MonthDayYear
Date

Employers Withholding Certificate

Federal W-4
Step 1

Enter Personal Information
(a) First name and middle initial
Last name
Adress
City or town, state, and zip code
(b) Social security number
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.
(c)

Single or married filing seperatelyMarried filing jointly or Qualifying surviving spouseHead of household
Check "Head of household" 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, other details, 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) Reserved for future use.
(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.

TIP: If you have self-employment income, see page 2.

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.)
Check this box for Step 2 (c)
Step 3

Claim Dependent and Other Credits
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 for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here

Step 4

(optional): Other Adjustments
(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.
(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.
(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*

Clear
Date

MonthDayYear
Employer's name and address

Greer's Green Thumb Lawn Care, LLC

1056 Woodshire Circle

Shreveport, LA 71107

Employer's Identification Number (EIN)

27 - 4423044
Employees first date of employement

MonthDayYear
Date

Louisiana Department of Revenue

Employee Withholding Exemption Certificate (L-4)
Purpose: Complete form L-4 so that your employer can withhold the correct amount of income tax from your salary.

Penalties will be imposed for willfully supplying false infomration or willfull failure to supply information that would reduce the withholding exemption

This form must be filed with your employer. If an employee fails to complete this withholding certificate, the employer must withhold Louisiana income tax from the employee without exemptions.
Block A
- Enter "0" to claim neither yourself nor your spouse, and check "No Exemptions or dependents claimed" under number 3 below. You may enter "0" if you are married, and have a working souse or more than one job to avoid having too little taxes withheld.
- Enter "1" to caim yourself, and check "Single" under number 3 below if you did not claim this exemption in connection with other employment, or if your spouse has not claimed your exemption. If you will file as head of house hold, enter "1" to calim one personal exemption and check "Single" under number 3 below.
- Enter "2" to claim yourself and your spoyuse, and check "Married" under number 3 below.
Block B
- Enter the number of dependents, not including yourself or your spouse, whom you will claim on you tax return. If no dependents are claimed, enter "0".
1. Type or print first name and middle initial
Last name
2. Social security number
3. Select one

No exemptions or dependents claimedSingleMarried
4. Home address (number and street or rural route)
City/State
Zip
6. Total number of exemptions claimed in Block A
7. Total number of exemptions claimed in Blok B
8. Increase of decrease in the amount to be withheld each pay period. Decrease should be indicate as a negative amount.
I declare under the penalties imposed for filing false reports that the numbers of exemptions and dependency credits claimed on this certificate do not exceed the number to which I am entitled.

Clear
9. Employer's name and adress

Greer's Green Thumb Lawn Care, LLC

1056 Woodshire Circle

Shreveport, Louisiana 71107-2837
10. Employer's state withholding account number

57116001
Should be Empty:

Registration

Your Contact Information

Emergency Contact Information

Banking Information

Other Information

Louisiana Office of Motor Vehicles

Personal Information

Authorization of Document Request

Authorization of Re-Disclosure

Employers Withholding Certificate

Step 1

Step 2

Step 3

Step 4

Step 5

Louisiana Department of Revenue