Work History/Historial de Trabajo

(please list the most recent job/por favor anote el empleo mas reciente)

Please mark the following if you have AT LEAST 3 MONTHS of experience:

The following are physical requirements pertaining to the job(s) for which you are applying. These recognized, bonafide physical requirements an ESSENTIAL FUNCTIONS of the job and are in addition to the skills, certification, years of experience or other qualifications required to perform he job(s) for which you have applied. This information will be used to determine appropriate job placement. It shall not be used to disqualify an otherwise qualified person. During an 8-hour shift. can you perform the following essential job functions with or without a reasonable accommodation?

Lo siguiente son requisitos que pertenecen al trabajo(s) para cual usted esta aplicando. Estos requisitos fisicos autenticos son FUNCIONES ESENCIALES del trabajo y son ademas se las habilidades, anos de experencia y otras calificaciones

 

The Company recognizes the employee's right to privacy; however, the Company is committed to providing a safe, efficient and productive work environment for all employees. In keeping with this commitment, employees and job applicants may be asked to undergo a drug/alcohol screening to determine the use of such substances. To further promote this goal, the Company will not tolerate the possession of or use of alcohol or drugs while on the Company's premises, or at any jobsite or assigned client location at any time. Employees are required to report to work in appropriate mental and physical condition to perform their jobs in a satisfactory manner. While on the Company's premises, or at any jobsite or assigned client location, and while conducting Company related business activities which may occur off the Company's premises, no employee of New View Staffing, Inc. shall use, possess, distribute, sell or be under the influence of alcohol or drugs (except for the use of physician prescribed medication when the employee's supervisor has been advised of such prescribed use The legal use of prescribed drugs is permitted on the job only if it does not impair an employee's ability to perform the essential functions of the job effectively and in a safe manner that does not endanger other individuals in the workplace.

Drug and alcohol tests may be conducted in any of the following situations:

POST OFFER: As a pre-qualification to assuming any position, prospective employees may be required to submit to a drug/alcohol test.

POST ACCIDENT: Any current employee who is involved in an incident or accident while on duty, whether on or off the Company's premises, or while performing services at an assigned client location, may be required to undergo a drug/alcohol test.

FITNESS FOR DUTY: This test may be required if significant and observable changes in an employee's performance, appearance, behavior, speech, etc. provides reasonable suspicion and probable cause to believe that the employee is under the influence of drugs or alcohol while on the Company's time or premises, or while performing services at an assigned client location which could result in injury to the employee or fellow employees, or subject the Company to legal exposure, or public embarrassment, the Company may require the employee to submit to a drug test. "Probable cause" shall exist when an employee's ability to perform their job duties is impaired. "Impaired" means that the employee's motor senses or judgment are or may be affected. Probable cause shall also exist if an employee is involvedin either a job related accident or violation of a safety rule or standard, which did or could have resulted in serious injury or property damage. Failure to submit to a drug test in any of the above-situations may result in immediate withdrawal of an offer of employment and/or immediate termination of the employee's employment.

I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT, AND I AGREE TO SUBMIT TO ANY SUCH TEST.

EMPLOYEE RELATIONS POLICY WITH ACKNOWLEDGMENT

New View Staffing Inc (the "Company") is committed to providing a work environment that is freeof discrimination. In keeping with this commitment, the Company maintains a strict policy prohibiting unlawful discrimination and retaliation. This policy applies to all employees of the Company, including supervisors and non-supervisory employees. The policy also prohibits unlawful discrimination and retaliation by non-employees of the Company with whom employees come into contact, including clients, customers, vendors and any other person doing business with the Company.

All aspects of employment with the Company will be governed on the basis of merit, competence and qualifications and will not be influenced in any manner by an individual's race, ancestry, color, religious creed (including religious dress and grooming practices), national origin, marital status, sex (including sexual harassment), sexual orientation, gender, gender identity, gender expression, disability (physical or mental including HIV/AIDS diagnosis), pregnancy (including breastfeeding and conditions related to breastfeeding), medical condition (cancer and genetic characteristics), age (40 or over), military and veteran status, or exercising the right to any legally provided leave of absence in the application of any policy, practice, rule or regulation.

All decisions made with respect to recruiting and hiring, evaluations and promotions for all job classifications will be based solely on individual qualifications as related to the requirements of the position. Likewise, all other personnel matters such as compensation, benefits, transfers, lay-offs, training, educational opportunities and programs will be administered free from any illegal discriminatory practices.

B.POLICY AGAINST HARASSMENT, INCLUDING SEXUAL HARASSMENT

The Company is also committed to providing a work environment that is free of harassment, including sexual harassment.

Sexual harassment includes:

• Unwanted sexual advances;
• Offering employment benefits in exchange for sexual favors;
• Making or threatening reprisals after a negative response to sexual advances;
• Visual conduct: leering, making sexual gestures, displaying of sexually suggestive objects or pictures, cartoons or posters;
• Verbal conduct: making or using derogatory comments, epithets, slurs, and jokes;
• Verbal sexual advances or propositions;
• Verbal abuse of a sexual nature, graphic verbal commentaries about an individual's body, sexually degrading words used to describe an individual, suggestive or obscene letters, notes, or invitations
• Physical conduct: touching, assault, impeding or blocking movement; and
• Further, the Company prohibits abusive conduct ("bullying"): Any form of abusive conduct by an employee in the workplace, with malice, that a reasonable person would find hostile, offensive, and unrelated to the Company's business interest.

C. COMPLAINT AND INVESTIGATION PROCEDURE

Any form of discrimination, retaliation or harassment, including sexual harassment, is absolutely prohibited. Any incident of possible discrimination, retaliation or harassment should be brought immediately to the attention of the Human Resources Department of the Company, either verbally or in writing, which will thoroughly investigate the matter. Supervisors who receive complaints of discrimination, retaliation or harassment from their employees are required to forward those complaintsto the Human Resources Department.

The Company will conduct a fair, impartial, and thorough investigation by qualified personnel that provides all parties appropriate due process. The investigation shall be conducted confidentially to the extent confidentiality is possible. The Company will document and track the progress of the investigation. The Company will make a reasonable determination, after reviewing all the evidence collected, concerning whether misconduct occurred. The investigation will be completed in a timely manner and the employee who filed the complaint will receive a timely response. If misconduct is found to have occurred, appropriate remedial measures will be taken. Disciplinary action, up to and including discharge, will be taken against any employee who is found to have engaged in conduct prohibited by this policy. No employee shall be subjected to any form of retaliation for reporting any violation of this policy truthfully and in good faith, or for participating in any investigation conducted pursuant to this policy.

HARASSMENT BY NON-EMPLOYEES

In addition, the Company will take all reasonable steps to prevent or eliminate sexual harassment by non- employees including customers, clients and suppliers who are likely to have workplace conduct with our employees.

Unless exempt, the employee identified on this notice is entitled to minimum requirements for paid sick leave under state law which provides that an employee:

a. May accrue paid sick leave and may request and use up to 3 days or 24 hours of accrued paid sick leave per year;

b. May not be terminated or retaliated against for using or requesting the use of accrued paid sick leave; and

C. Has the right to file a complaint against an employer who retaliates or discriminates against an employee for

1. requesting or using accrued sick days;

2. attempting to exercise the right to use accrued paid sick days;

3. filing a complaint or alleging a violation of Article 1.5 section 245 et seq. of the California Labor Code;

4. cooperating in an investigation or prosecution of an alleged violation of this Article or opposing any policy or practice or act that is prohibited by Article 1.5 section 245 et seq. of the California Labor Code.

The following applies to the employee identified on this notice: (Check one box)

1. Accrues paid sick leave only pursuant to the minimum requirements stated in Labor Code $245 et seq. with no other employer policy providing additional or different terms for accrual and use of paid sick leave.

2. Accrues paid sick leave pursuant to the employer's policy which satisfies or exceeds the accrual, carryover, and use requirements of Labor Code $246.

3. Employer provides no less than 24 hours (or 3 days) of paid sick leave at the beginning of each 12-month period.

4. The employee is exempt from paid sick leave protection by Labor Code $245.5. (State exemption and specific subsection for exemption):

The employee's signature on this notice merely constitutes acknowledgement of receipt.

Labor Code section 2810.5(b) requires that the employer notify you in writing of any changes to the information set forth in this Notice within seven calendar days after the time of the changes, unless one of the following applies: (a) All changes are reflected on a timely wage statement furnished in accordance with Labor Code section 226; (b) Notice of all changes is provided in another writing required by law within seven days of the changes.

Employees that are scheduled to work more than five (5) hours must take a thirty (30) minute uninterrupted meal period, off the clock, no later than the end of the fifth hour of work. Employees are entitled to be relieved of all their duties and free to take care of personal matters during that time. Employees that have a six (6) hour shift may voluntarily waive the meal period if they execute a Six Hour Shift Waiver Form. Please see the Human Resource Department.

The Company provides a paid ten (10) minute rest period for every four (4) hours of work or major fraction thereof. An employee who works between three and a half (3 1/2) to six (6) hours is entitled to one (1) ten minute break, an employee who works over six (6) hours is entitled to a second ten minute break. An employee that works less than three and a half 3 1/2) hours is not entitled to receive a paid ten (10) minute rest period. Please check with your supervisor for the appropriate time to take a meal and rest breaks.

Meal periods and rest periods may not be waived to leave early nor may they be consolidated for a longer break or meal period.

It is against Company policy for any employee to perform work during meal or rest periods. It is against Company policy to return to work before the end of a 30 minute meal period or ten minute rest break. It is also against Company policy for employees to work "off the clock," that is, perform work without recording it as time worked on their timesheets.

Employees working more than ten (10) hours are entitled to a second meal period before the end of the tenth hour of work, unless the employee voluntarily executes a Twelve Hour Shift Waiver Agreement and has taken the first meal period.

The undersigned acknowledges that he or she has read and understands the foregoing Meal and Rest Period Policy.

MUTUAL AGREEMENT TO ARBITRATE CLAIMS

New View Staffing, Inc.(the "Company") and _____________ ("Employee") hereby agree that any and all disputes, claims or controversies arising out of or relating to this Mutual Agreement to Arbitrate Claims (the "Agreement"), the employment relationship between Employee and Company or otherwise concerning, relating to or arising out of the services provided by Employee to clients of Company, or the termination of the employment relationship, that are not resolved by their mutual agreement, shall be resolved by final and binding arbitration by a neutral arbitrator, in the State of California. This Agreement includes any claims that the Company may have against the Employee, or that Employee may have against the Company or against any of their respective officers, directors, employees, agents, or parent, subsidiary, or affiliated entities.

1. _________ The terms of this Agreement supersede any prior or subsequent oral discussions or agreements you may or have had with the Company about arbitration or resolving disputes with the Company.

2. __________ The claims covered by this Agreement include, but are not limited to, claims for wrongful termination; breach of any contract or covenant, express or implied; breach of any duty owed to Employee by Company or to Company by Employee; personal, physical or emotional injury; fraud, misrepresentation, defamation, and any other tort claims; wages or other compensation due; penalties; benefits; reimbursement of expenses; discrimination or harassment, including but not limited to discrimination or harassment based on race, sex, pregnancy, religion, national origin, ancestry, age, marital status, physical disability, mental disability, medical condition, or sexual orientation; retaliation; violation of any federal, state or other governmental constitution, statute, ordinance or regulation (as originally enacted and as amended), including but not limited Title VII of the Civil Rights Act of 1964 ("Title VII"), Age Discrimination in Employment Act of 1967 ("ADEA"), Americans with Disabilities Act ("ADA"), Fair Labor Standards Act ("FLSA"), Employee Retirement Income Security Act ("ERISA"), Consolidated Omnibus Budget Reconciliation Act ("COBRA"), Family and Medical Leave Act ("FMLA"), California Fair Employment and Housing Act ("FEHA"), California Family Rights Act ("CFRA"), California Labor Code, California Civil Code, and the California Wage Orders. This Agreement shall not apply to any dispute if an agreement to arbitrate such dispute is prohibited by law. Nothing in this Arbitration and Class Action Waiver section, however, restricts Employee's right, if any, to file in court a representative action under California Labor Code Sections 2698, et seq., but parties agree that any such representative action shall be stayed pending the outcome of any and all arbitrable claims. SUBJECT TO THE ABOVE PROVISO, THE

PARTIES HEREBY WAIVE ANY RIGHTS THEY MAY HAVE TO TRIAL BY JURY IN REGARD TO ARBITRABLE CLAIMS. THE PARTIES FURTHER WAIVE ANY RIGHTS THEY MAY HAVE TO PURSUE OR PARTICIPATE IN A CLASS OR COLLECTIVE ACTION PERTAINING TO ANY ARBITRABLE CLAIMS BETWEEN EMPLOYEE AND THE COMPANY.

3._________ In arbitration, each side in the dispute presents its case, including evidence, to a neutral third party called an "arbitrator," rather than to a judge or jury. The arbitrator is either an attorney or a retired judge. The parties are entitled to be represented by their own legal counsel in the arbitration proceeding. After reviewing the evidence and considering the arguments of the parties, the arbitrator makes a decision (award) to resolve the dispute. The arbitrator's decision is final and binding which means there will be no trial by a judge or jury or an appeal of the arbitrator's decision. Arbitration normally is more informal and much speedier and less expensive than a lawsuit. Because of the large number of cases awaiting

Trial in many courts, a dispute normally can be heard much more quickly by an arbitrator than by a judge or jury.

4. _______ By signing this Agreement, the parties agree that any arbitration shall be conducted before a single neutral arbitrator selected by the parties and shall be conducted under the JAMS Employment Arbitration Rules & Procedures ("JAMS Rules") then in effect. Employees may obtain a copy of the JAMS Rules by accessing the JAMS website at www.jamsadr.com. By signing this Agreement, the Employee acknowledges that he/she has had an opportunity to review the JAMS Rules before signing this Agreement. The arbitration shall take place in or near the city in which the Employee is or was last employed by the Company.

5. ________ The arbitrator shall have the authority to order such discovery by way of deposition, interrogatory, document production, or otherwise, as the arbitrator considers necessary to a fullandfair exploration of the issues in dispute, consistent with the expedited nature of arbitration. The arbitrator is authorized to award any remedy or relief available under applicable law that the arbitrator deems just and equitable, including any remedy or relief that would have been available to the parties had the matter been heard in a court. Nothing in this Agreement shall prohibit or limit the parties from seeking provisional remedies under California Code of Civil Procedure section 1281.8, including, but not limited to, injunctive relief from a court of competent jurisdiction.

6. _________ The arbitrator shall have the authority to provide for the award of attorney's fees and costs if such award is separately authorized by applicable law. Employees shall not be required to pay any cost or expense of the arbitration that he or she would not be required to pay if the matter had been heard in a court. The decision of the arbitrator shall be in writing and shall provide the reasons for the award unless the parties agree otherwise. This Agreement is enforceable under and subject to the Federal Arbitration Act, 9 U.S.C. Sec 1 et. seq. (the "FAA")

7. _________ The Company reserves its right to amend or modify this Agreement at any time at its sole and absolute discretion provided that the Employee is provided with written notice of the same.

8. __________ The parties agree that there is good and valuable consideration for the execution of the Agreement, including but not limited to, Employee's continued employment with Employer, the requirement that the agreement to arbitrate all claims is mutual between the parties, and other good and valuable consideration.

9.In the event that any provision of this Agreement is held to be void, null, unlawful, or unenforceable, the remaining portions will remain in full force and effect.

10._________ Notwithstanding the unavailability of class or collective arbitration under this Agreement, nothing herein is intended to limit an employee's rights that exist under Section 7 of the National Labor Relations Act and Employee will not experience any retaliation for exercising such rights.

Full-Time and Part-Time Employees

Employees who have worked at least thirty (30) days are entitled to paid sick leave under the Healthy Workplaces, Healthy Families Act. Eligible employees will be granted a total of twenty-four (24) hours of paid sick time every year on their date of hire. Any unused sick leave will not carry over from year to year. Employees may not use more than twenty-four (24) hours of sick leave per year. Paid sick leave must be used in increments of a minimum of two (2) hours.

Use of Sick Time

Employees are entitled to use paid sick time starting on the 90th day of employment for the following reasons: (1) diagnosis, care or treatment of an existing health condition of the employee or a covered family member of the employee, (2) preventative care for the employee or a covered family member of the employee, and (3) for court dates, medical treatment, or counseling or safety planning when the employee is a victim of domestic violence, sexual assault or stalking. Covered family members include the employee's parent, child, spouse, registered domestic partner, grandparent, grandchild, sibling, and spouse's or registered domestic partner's parent, or any individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship.

If the need for paid sick leave is foreseeable, employees must provide advance oral or written notification to their supervisor or Human Resources. Advance notice requires notification at least one-half (1/2) hour before the employee's scheduled starting time. If the need for paid sick leave is not foreseeable, employees must provide notice to their supervisor or Human Resources as soon as practical. An employee's use of paid sick time may run concurrently with other leaves under state or federal law.

Unused sick time accrued will not be made payable to employees upon leaving the service of the Company, regardless of the reason for separation. Employees who are rehired within one year of separation from employment are eligible for reinstatement of previously accrued paid sick time. Payment for sick days is not considered as time worked in the computation of overtime.

Employees will generally be required to submit a certification from their treating licensed medical care practitioner upon returning to work after an absence of three (3) consecutive days or more. Employees will be required to provide a release from their medical care practitioner to return to work if the employee is hospitalized for twenty-four (24) hours or more or for outpatient surgery.

| understand under California Labor Law, after a work period of 5 hours, I am entitled to receive an unpaid meal break of not less than 30 minutes.

Voluntary Waiver of Meal Periods on Shifts Over 5 hours and up to 6 hours

I understand that anytime I work a shift over 5 hours long, I will be provided with a duty-free and unpaid meal period of at least 30 minutes. | understand that I can voluntarily agree to waive my first meal period if I do not work more than 6 hours on that shift.

_______By initialing this box, I voluntarily agree to waive my 30-minute unpaid meal break only when my work and/or scheduled shift will be completed in 6 hours or less in one workday. | understand that if my shift exceeds 6 hours, I am required to take an unpaid meal break of at least 30 minutes.

Voluntary Waiver of Meal Periods on Shifts Over 10 hours and up to 12

I understand that anytime I work shifts over 10 hours long, I will be provided with a second duty-free and unpaid meal period of at least 30 minutes. I understand that I can voluntarily agree to waive this second meal period as long as I take my first meal period and I do not work more than 12 hours on that shift.

_________ By Initializing this box, | voluntarily agree to waive my meal period when I work shifts over 10 hours and up to 12 hours long. I understand that I will receive only one duty-free meal period when I work shifts of this length. I also understand that I must take a second meal duty-free meal break of at least 30 minutes when | work over 12 hours in one day, regardless of this waiver.

I acknowledge that have read this waiver, understand it, and voluntarily agree to it. I further understand that I may revoke this waiver at any time by providing advance notice in writing. This waiver will remain in effect for the duration of my assignment or until it is revoked by me, in writing.

 

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

Step 3 :

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 3 this the amount of any other credits. Enter the total here...... $ ___________

Step 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. (optional): This may include interest, dividends, and retirement income4(a) Other Adjustments

(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 4(b)

(c) Extra withholding. Enter any additional tax you want withheld each pay period

Under penalties of perjury, 1 declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.

ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.

Section 1. Employee Information and Attestation: Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.

I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

 

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3. Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions. List A

Issuing Authority Document Number (if any) Expiration Date (if any) Document Title 2 (if any) Issuing Authority Document Number (if any) Expiration Date (if any) Document Title 3 (if any) Issuing Authority Document Number (if any) Expiration Date (if any) Certification: | attest, under penalty of perjury, that (1) | have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to the best of my knowledge, the employee is authorized to work in the United States.

Check here if you used an alternative procedure authorized by DHS to examine documents. First Day of Employment (mm/dd/yyyy):