ESS BROWARD

Employment Eligibility Verification
Check one of the following boxes to attest to your citizenship or immigration status*

A citizen of the United StatesA noncitizen national of the United StatesA lawful permanent residentAn alien authorized to work until
USCIS #*
USCIS #*
Expiration Date*

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Date
Signature*

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Date of Birth*

MonthDayYear
MM/DD/YYYY
Today's Date*

MonthDayYear
Date

Employee's Withholding Certificate (W4)

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
How will you be filing?*

Single or Married filing separatelyMarried filing jointly or Qualifying surviving spouseHead of household (Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and qualifying individual.)
Claim Dependent and Other Credits
Are you going to be claiming any dependents?*

NoYes
Total number of qualifying children under the age of 17
Total
Total number of other dependents (18+ years old)
# of dependents x 500 =
Total
Total $ amount of dependents
Extra withholding (optional)
Enter any additional tax you want withheld each pay period
Signature*

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Candidate Agreement & Seasonal / Event-Based Work Assignments Acknowledgment
You agree to be responsible for submitting your Employer Solutions Services Inc. (ESS) timecard at the end of each week, signed by a client supervisor to the assigned facility or sent into payroll. You agree to submit such timecard and call the office no later than 11:00 A.M. on Tuesday to ensure we received your timecard. You also understand that your paycheck will be available on Friday, you may cash or deposit your check on Friday. You have the option of picking up your check at ESS office or have it mailed out to you.

Terms and Conditions of Employment

I accept that:

a. My failure to contact ESS by phone within two business days of completion of assignment may lead to the denial and/or interruption of unemployment benefits.

b. If a suitable assignment is available with ESS upon conclusion of my assignment and I fail to inquire about another assignment before filing for unemployment benefits, it may lead to an interruption and/or denial of unemployment benefits.

c. If a suitable assignment is available with ESS upon conclusion of my assignment and I refuse an offer of suitable work, it may lead to an interruption and/or denial of unemployment benefits.

d. I will call ESS weekly when I am not on assignment with ESS to verify my availability to work.

e. I understand that my rate of pay may change with each assignment.

Due to the nature of our business, a temporary staffing service, all employees are required to show up for assignment on time and prepared to work. If you are unable to show up for work on time and prepared, you must call ESS and report your situation to us. If you refuse or neglect to show up for your assignment, it is considered job abandonment.

You agree to indemnify Employer Solutions Services Inc. from any and all liability, loss and damage or expense, which may be caused by your negligence or failure to perform your duty under the terms of this agreement.

By reading and signing this document, I acknowledge that many of the work assignments offered through Employer Solution Services, Inc. (ESS) may be seasonal or event-based, often lasting from a few days to a few weeks. I understand that the conclusion of an assignment does not constitute termination from ESS. Rather, it indicates that the assignment has been completed as scheduled—whether communicated via phone call or in person—and that I will remain on the active candidate list for future opportunities.

I also understand that due to the seasonal or event-based nature of these assignments, there may not always be immediate work available. It is my responsibility to maintain communication with ESS by checking in periodically to update my availability and express continued interest in open positions.
Full Name*
First & Last Name
Signature*

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Applicant Acknowledgement & Release
PLEASE READ CAREFULLY BEFORE SIGNING

A. CONDITIONS OF EMPLOYMENT

I will not accept any work directly from an ESS client to which I have previously assigned without first contacting ESS.
I understand that my rate may change with each assignment.
I authorize the investigation of all matters contained in this application and hereby give the employer permission to contact schools, previous employer, criminal background screening, references, and other, and hereby release the employer of any liability as a result of such contact.
I understand that I am required to call a representative of ESS each time an assignment ends. If I am not reassigned immediately, I must call at least every week for availability.
I understand that failure to comply with this requirement will result in denial of employment compensation benefits.
I understand that ESS is a staffing service and cannot guarantee me a set amount number of hours.

B. DRUG FREE WORKPLACE

APPLICANT AUTHORIZATION AND ACKNOWLEDGEMENT
I understand that ESS is a drug free employer.
Further, I understand that during my employment, I may be required to submit testing for the presence of drug and/or alcohol, I understand that submission to such testing is a condition of employment with ESS and disciplinary action, limited to and including discharge may result if:
I refuse to consent such testing,
I refuse to execute all forms of consent and release of liability as are usually and reasonably attendant to such examinations,
I refuse to authorize release of the test result to ESS,
The test establishes a violation of ESS Drug Free Policy
Otherwise violate the policy.
If I am injured in the course and scope of my employment and test positive, I forfeit my eligibility for medical and indemnity benefits under the Worker’s Compensation Act upon exhaustion of the remedies provided in Florida Stature 44.102(5).
Certain companies, to whose location(s) an employee is assigned, require all employees to be tested before beginning work. Any Employer Solution Services Inc. Employee choosing not to accept assignments where such test is required will not be adversely treated in regard to other assignments which do not require testing. However, any employee who accepts an assignment with ESS at a company requiring drug testing will be terminated if test results are positive.
I hereby acknowledge that I have read and understood the above conditions of employment and understand that failure to comply with any policy or condition of employment, including Employer Solutions Services Inc. Drug Free Workplace as described, will result in termination of employment. I also understand that the above conditions are not intended to constitute a contract Between ESS and me.
Signature*

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Employee Accident & Injury Reporting Agreement
Signature*

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Signature*

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8850 Pre-Screening Notice and Certification Request for the Work Opportunity Credit
Are you under the age of 40?*

YesNo
Please enter your date of birth

MonthDayYear
Date
Please select any that applies to you

Check here if you received a conditional certification from the state workforce agency (SWA) or a participating local agency for the work opportunity credit.I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9months during the past 18 months. I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps) for at least a 3-month period during the past 15 months. I was referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program, or the Department of Veterans Affairs. I am at least age 18 but not age 40 or older and I am a member of a family that: a. Received SNAP benefits (food stamps) for the past 6 months; or b. Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is no longer eligible to receive them. During the past year, I was convicted of a felony or released from prison for a felony. I received supplemental security income (SSI) benefits for any month ending during the past 60 days. I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during the past year.Check here if you are a veteran and you were unemployed for a period or periods totaling at least 6 months during the past year.Check here if you are a veteran entitled to compensation for a service-connected disability and you were discharged orreleased from active duty in the U.S. Armed Forces during the past year.Check here if you are a veteran entitled to compensation for a service-connected disability and you were unemployed for a period or periods totaling at least 6 months during the past year.Check here if you are a member of a family that: Received TANF payments for at least the past 18 months; or Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended during the past 2 years; or Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be made.Check here if you are in a period of unemployment that is at least 27 consecutive weeks and for all or part of that period you received unemployment compensation.
Signature*

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Pay Selection Agreement
Employer Solutions Services, Inc. offers employees two payment options. You may choose either a pay card or a direct deposit.*

I choose to have my pay deposited directly to my pay card. My manager will give me my Money Network pay card and information kit to me. My net pay will be deposited into the pay card each payday.I choose to have my paycheck deposited directly to a checking/ savings account. I have attached a voided check, check photocopy, deposit slip, or other forms of bank account documentation and have the authorization statement below.
Direct Deposit Information

Bank NameRouting NumberAccount Number
Account Type

CheckingSavings
Please upload a copy of your bank account documentation.

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ACKNOWLEDGMENT OF RECEIPT OF EMPLOYEE HANDBOOK
I have received a copy of Employer Solutions Services Inc.’s Employee Handbook. I understand and agree that it is my responsibility to read and comply with the policies contained in this handbook. I further understand that all previously issued handbooks, and any inconsistent policy statements or memoranda, are superseded by this Employee Handbook. In the event I have a written employment agreement with the Company which is contrary to or inconsistent with any of the policies set forth in this Employee Handbook, the terms of the written agreement are controlling.

I understand and agree that my relationship with the Company is “at-will”, which means that my employment is for no definite period and may be terminated by me or by the Company at any time, with or without cause or advance notice. I also understand that the Company may demote or discipline me or otherwise alter my terms of my employment at any time at its discretion, with or without cause or advance notice. I further understand that nothing in the Employee Handbook alters my at-will employment relationship.

No one other than the Company’s CEO has the authority to alter this at-will employment arrangement, or to enter an agreement for employment for a specific period, or to make any express or implied agreement contrary to this policy. Furthermore, any such agreement must be in writing and must be signed by the CEO. I understand that no other employee or representative of the Company has any authority to enter into any such agreement, and that any agreement to employ me for any specified period or that is otherwise inconsistent with the terms of this Acknowledgement will be unenforceable unless in writing and signed by me and the CEO.

I further understand that the policies contained in the handbook are guidelines only and are not intended to create any contractual rights or obligations, express or implied. I also understand that the Company has the right to amend, interpret, modify, add or withdraw any of the policies in its sole discretion, with or without notice, except for the Company’s policy of at-will employment.
Signature*

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Document Upload
Please upload a picture of your ID here. If you have a list A document such as Passport card, work permit, or permanent resident card, please upload the front and back. If you have a list B document, you must also upload a list C document.

Examples: List A

Box 1: Box 2:

List B & C

Box 1: Box 2:
Box 1. *

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Box 2.*

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Should be Empty:

Skill Classifications

NOTE TO ALL LABORERS:

Employment Eligibility Verification

Employee's Withholding Certificate (W4)

Claim Dependent and Other Credits

Candidate Agreement & Seasonal / Event-Based Work Assignments Acknowledgment

Applicant Acknowledgement & Release

Employee Accident & Injury Reporting Agreement

Enrollment Form

Required Dependent Information

Beneficiary Information

Declination of Health Coverage

8850 Pre-Screening Notice and Certification Request for the Work Opportunity Credit

WOTC (Work Opportunity Tax Credit) Questionnaire

Pay Selection Agreement

ACKNOWLEDGMENT OF RECEIPT OF EMPLOYEE HANDBOOK

Document Upload