Seymour Application & Onboarding

Employment Application

CFA Staffing is an equal opportunity employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition or any legally protected status by local, state or federal laws. Equal access to the hiring, services and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Branch Manager.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

Personal Information*

Social Security Number

Full Name*

First NameMiddle NameLast Name

Phone Number*

Main Phone #

Alternate Number

Alternate Phone #

Address*

Street Address

Street Address Line 2

CityState

Zip Code

E-mail

Optional - Gender Preference

Choose One

Optional - Ethnicity

Choose One

Position(s) applying for*

Wage expectations

Salary or Hourly?

Referral source*

Are you 18 years old or older?*

YESNO

Are you eligible to work in the United States?*

YESNO

Are you currently employed?*

YESNO

Are you able to do repetitive tasks?*

YESNO

Are you able to stand at least 8 hours?*

YESNO

Are you able to lift at least 25lbs?*

YESNO

Do you have relatives employed with our company?*

YESNO

Will you submit to pre-employment and random drug screenings?*

YESNO

Date available for work*

MonthDayYear

Are you available to work?*

Full timePart timeShift workTemporary

Have you previously applied with our company?*

YESNO

If yes, give date:

Have you ever been convicted of a felony/misdemeanor (other than traffic violations)?*

YESNO

If so, provide the location, date and result/outcome for each conviction:*

EDUCATION

Highest level of education completed:*

Please complete the appropriate sections

	Name of School	Location of School	Graduation Year	Degree or Certification
GED / High School
Trade School
College
Graduate

WORK HISTORY

Please list two of your most recent employers, list the most recent first

1. Employer

Employer's Name (Most current)*

Address & location of business*

Job Title*

May we contact this employer?*

YESNO

Supervisor's name*

Supervisor's Phone Number

Start Date

Date

End Date

Date

Starting Wage:*

Ending Wage:*

Salary or Hourly*

Job Duties:*

Reason for leaving*

2. Employer

Employer's Name (Second most recent)

Address & location of business

Job Title

May we contact this employer?

YESNO

Supervisor's name

Supervisor's Phone Number

Starting Wage:

Ending Wage:

Salary or Hourly

Job Duties:

Reason for leaving

ADDITIONAL INFORMATION

Do you have a U.S. military service record?*

YESNO

If yes, branch of service*

Discharge date and rank*

List job-related accomplishments, projects, and awards. (Exclude information that would reveal race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status.)

REFERENCES

Maybe required at a later date.

ADDITIONAL SKILLS

Select all that Apply

PAYROLL INFORMATION

Tax Filing Status*

Tax Exemptions & Withholdings*

	Exemptions	Additional withholdings
Federal
State

CFA Policy requires direct deposit or paycard.

How would you prefer to be paid?*

HEALTH COVERAGE

Health Coverage - ACA Plan

AUTHORIZATION

I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during the interview process is grounds for disqualification from further consideration for employment or for termination, if employed. I authorize CFA Staffing to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, and qualifications. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.

Pre-employment testing may be required.

I understand that if hired, employment is at-will, and may be terminated by myself or CFA Staffing at any time, with or without cause or notice, for any reason or no reason.

By entering your name and signing below you agree to accept the terms of the above document with an electronic signature.*

I agreeI do not agree

You must agree to accept the terms of the document in order to submit an application.

Type signature*

Signature

Date*

MonthDayYear

Upload your resume and cover letter, click Choose File

Upload a File

New Hire Onboarding

Seymour 2025

Employee Name*

First NameLast Name

Date

I would like my pay check to be*

Put on a Pay cardDirectly deposited into my bank account

Direct Deposit Information

I hereby authorize CFA Staffing to initiate automatic deposits to my account at the financial institution named below. I also authorize CFA Staffing to make withdrawals from this account in the event that a credit entry is made in error.

Further, I agree not to hold CFA Staffing responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

This agreement will remain in effect until CFA Staffing receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.

Bank Account Type (choose one)

CheckingSavings

Name of Bank*

Bank Routing #*

VERIFY IF CORRECT

Re-enter Bank Routing #*

VERIFY IF CORRECT

Try Again! I think something wrong with your routing number.

Bank Account #*

VERIFY IF CORRECT

Re-enter Bank Account #*

VERIFY IF CORRECT

Try Again! I think something wrong with your account number.

Term of Authorization*

I agree this authorization will be in effect until CFA Staffing receives a written termination notice from me and has a reasonable opportunity to act on it.

Summary or Your Rights Under the Fair Credit Reporting Act

Background & Drug Screen Information

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

CFA Staffing (“the Company”) may obtain information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by PeopleFacts LLC. 135 Chesterfield Lane Maumee, OH 43537 800-772-0130 www.peoplefacts.com. The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.

The information requested below is collected solely for the purpose of aiding the CFA in running a background check in connection with your application for employment. The employer is requesting that you provide this information to assist in conducting a thorough background check.

For residents of, or for jobs located in Utah, please do NOT provide your date of birth, social security number or driver’s license number until instructed to do so by the Company.

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK*

I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by CFA Staffing at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by PeopleFacts LLC. at 135 Chesterfield Lane Maumee, OH 43537 800-772-0130 www.peoplefacts.com and/or CFA Staffing. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

Social Security Number*

Date of Birth*

Date

Driver's License Number*

State Issuing License*

Street Address

Street Address Line 2

State

Any Nickname(s) Used

Enter any other names used (including maiden names)

	First Name	Middle Name	Last Name
1.
2.
3.

Payroll Deduction for Background and Drug Screens

It is required for all CFA temporary associates to have a pre employment drug screen and criminal background check ran.

Temporary associates will be charged $20.00 for a drug screen and $37.00 for the background check.

All costs will be deducted from your paycheck.

Text Messages

Policies & Procedures

SAFETY POLICY

The safety rules listed below have been developed to reduce the risk of injury to our employees. Your cooperation in maintaining a safe work environment is critical and appreciated. Management reserves the right to determine whether your actions constitute a safety hazard.
Please understand this list is not comprehensive and other safety regulations exist that are not represented on this list.

All incidents, injuries, and near misses are to be reported to your CFA supervisor immediately.
Personal protective equipment (PPE) must be worn where required.
Dress code standards must be followed.
Shoes must cover the entire foot; no open toes or heels are allowed. Steel toed safety shoes may be required in certain areas.
Only authorized employees may operate or service any type of moving equipment (forklifts, conveyors, hoists, etc.).
Climbing on, over, or under equipment when it is in operation, is not allowed, unless the machine has been properly locked out.
Running on company property is not allowed.
Horseplay and roughhousing on company property is not allowed.
Smoking is authorized in designated areas only.

SUBSTANCE ABUSE POLICY

Employees are expected and required to report to work on time and in appropriate mental and physical condition for work. It is our intent to provide a drug and alcohol-free, safe and secure working environment.

The unlawful manufacture, distribution, possession or use of any illegal substance on company premises or while conducting company business off company premises is absolutely prohibited. Violations of this policy will result in disciplinary action, up to and including termination and may also result in legal consequences.

Employees must, as a condition of employment, abide by the terms of the above policy and report any conviction under a criminal drug statute for violations occurring on or off company premises. Report of a conviction must be made within (5) five days after the conviction. (This requirement is mandated by the Drug-Free Workplace Act of 1988.)

Many of our clients have random drug screening programs. As a condition of employment, you must agree to be a willing participant in these programs. Failure to do so will result in disciplinary action, up to and including termination of employment.

Associates compromised by drugs or alcohol at the worksite will be immediately removed and subject to termination.

HARASSMENT-FREE WORK ENVIRONMENT

CFA Staffing strictly prohibits all forms of harassment, including sexual and racial harassment and harassment based on any of the protected characteristics described above. A person's actions, words, or behavior must not create an intimidating, hostile, or offensive environment.
Sexual harassment includes, but is not limited to, making unwelcome advances, sexual flirtations or propositions, continual or repeated verbal abuse of a sexual nature, graphic verbal commentaries about an individual's body, sexually degrading words used to describe an individual, humor and jokes about sex or gender-specific traits, sexual innuendo, display in the workplace of sexually suggestive objects or pictures, and transmission of sexual messages via voice mail, regular mail, e-mail or the Internet or Intranet.

No CFA employee shall state or imply that rejection of sexual advances will adversely affect another person's conditions of employment or career development.

Harassment in any form by a contractor, client representative or CFA employee needs to be reported and this report will be forwarded to the proper supervising contact for proper review and disposition.

All contract or temporary workers are responsible for making sure that the workplace is free from all harassment. If a contract or temporary worker experiences any harassment, he or she should contact his or her supervisor immediately.

CFA Staffing prohibits retaliation against any contract or temporary worker who reports or seeks to stop harassment, or who participates in an investigation.

THREATS & VIOLENCE in the WORKPLACE

CFA Staffing has adopted a Zero-Tolerance policy on workplace violence. Acts or threats of physical violence, including intimidation, harassment, and/or coercion that involves or affects CFA Staffing employees or its customer will not be tolerated. Specific examples of conduct which may be considered threats or acts of violence include but are not limited to the following:

Hitting or shoving an individual
Threatening harm to an individual or his/her family, friends or associates
The intentional damage or destruction of or threat of damage or destruction to property.
Harassing or threatening phone calls
Harassment or stalking
The suggestion or intimation that violence is appropriate
Possession or use of firearms or weapons under any circumstances on CFA or customer property, or elsewhere in connection with employment with CFA is prohibited.

Violations of this policy will lead to disciplinary action, up to and including termination, and/or legal action as appropriate. Every CFA Staffing employee is encouraged to report incidents or threats or acts of physical violence. The report may be made at a CFA office, or to the reporting individual’s supervisor, or another supervisory employee if the immediate supervisor is not available.

PROCEDURES & GUIDELINES

We are glad you have chosen CFA as your new employer. The following are general guidelines.

ASSIGNMENTS- When you are offered a job assignment, your CFA recruiter will relay all important information regarding that assignment.
PLEASE DO NOT ACCEPT ANY ASSIGNMENT YOU CANNOT COMPLETE! If you begin an assignment, you must finish the shift. If you decide to end the assignment, call your CFA recruiter immediately after your shift and request a different assignment. Your recruiter will work with you to find more suitable work.
TIMELINES- It is expected all associates will arrive on time. Please have a back-up plan for unexpected issues.
TIMEKEEPING- Timekeeping is your responsibility. Each assignment is different, it is very important to understand the timekeeping procedure for your job assignment.
OVERTIME- Overtime is only accumulated if it is all worked at the same client. You CANNOT earn overtime if it is at two different client locations in the same week.
DRESSCODES- Some job assignments require certain dress codes, regarding specific pants, shirts, footwear, personal protective equipment (PPE), jewelry, etc. Please obtain all information regarding dress codes before accepting an assignment.
PAYCHECKS- Time submitted on time will be paid the Friday after the week the work was completed, unless your pay period is bi-weekly. FRIDAY IS PAYDAY!
MISSING WORK- We understand that it may be necessary for you to miss work. CFA requires a 24-HOUR NOTICE for any scheduled appointments (i.e. doctor’s appts, court dates, etc.). At least ONE-HOUR NOTICE is required for emergencies or last-minute issues.
NEW ASSIGNMENTS- When your assignment ends you have 24 hours to contact CFA about a new assignment. If you do not contact CFA you will be taken off of our active roster.

FMLA

Eligibility Requirements
Employees are eligible if they have worked for a covered employer for at least 12 months, have 1,250 hours of service in the previous 12 months*, and if at least 50 employees are employed by the employer within 75 miles.

Employee Responsibilities
Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days advance notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call in procedures.

Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave.

For Additional information and forms please contact the local office.

Employee Authorization Signature*

Date

Federal Withholding

W-4/2024

Form must be completed and signed.

State Withholding

Form WH-4 48845 (R10/8-23)

Form must be completed and signed.

You will be directed to the Federal and State forms link once you have completed the application and the onboarding by clicking on "submit" below.