Application Form: Employee Hardship Program
This program offers one-time monetary assistance to eligible employees in times of financial hardship as defined below. Requests up to $1,200 will be accepted. In order to be eligible, an employee must have completed 90 days of employment, must have submitted an application, must not be on any other payment plan with BGCGG, and must have received no warning notices in the preceding 90 days. A financial hardship is a sudden and significant strain caused by circumstances beyond the employee's control.
Employee Name (entered as it appears on Paycom):
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First Name
Middle Name
Last Name
Date Submitted:
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Month
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Day
Year
Date
Email Address:
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example@example.com
Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
I am requesting assistance through the Employee Hardship Program.
What is the amount of financial assistance you are requesting?
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Briefly describe the current financial hardship you are facing.
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How might this one-time support relief?
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Is there any other support that you need and would you like to be connected with additional resources?
I certify that the information provided is true and accurate, that the request meets the hardship definitions outline, and that misrepresentation may lead to corrective action or repayment back to the program.
Employee Signature
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Date
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Month
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Day
Year
Date
Submit
Submit
Should be Empty: