Labor Work Solutions Employment Form (EN)  Logo
  • Employment Application Form

    LWS IS AN EQUAL OPPORTUNITY EMPLOYER. ALL APPLICANTS AND ASSOCIATES ARE CONSIDERED ON THEIR OWN MERIT WITHOUT REGARD TO RACE, COLOR, SEXUAL ORIENTATION, AGE, RELIGIOUS PREFERENCE OR CREED, NATIONAL ORIGIN, MARITAL STATUS, OR PHYSICAL LIMITATION.
  • Personal Information

  • EEO-1 Report Information

    The following information pertains to applicable annual federal EEO-1 reports. Information received will not be used in any way to evaluate the employee.
  • Emergency Contact

  • Employment Information

  • Work Experience

  •  - -
  • Powered by Jotform SignClear
  •  - -
  • Employment Application

  •  - -
  • Powered by Jotform SignClear
  •  - -
  • Employment Application (continued)

    Welcome to Labor Work Solutions, LLC (here in after "LWS”). The company for which you perform services uses LWS to issue your paychecks, process your year-end W-2s, and to offer a variety of employee benefits for your consideration. Under this application, you will be considered an employee of LWS. All information contained in this employment application is important to your employment with LWS. All blanks must be completed, and youmust sign the application, including the 1-9 and W-4. A copy of your Social Security card is requested for employment tax purposes.
  • At-Will Employment

    I, the undersigned employee, in consideration of my hiring by LWS as an at-will staffed employee of LWS acknowledge and agree to the following: I have been hired as an at-will employee of LWS which is an employee staffing company and there is no contract of employment which exists between me and the client to which I have been assigned, nor between LWS and me. I understand and agree that either LWS or I can terminate our employment relationship at any time, as I am an at-will employee. I also agree that I may be assigned to an affiliated LWS company and employed by such company at any time at the sole and complete discretion of LWS and without my consent or agreement. I also agree that while I am a staffed employee of LWS, if LWS does not receive payment from client for services which I perform as a staffed employee, LWS will still pay me the applicable minimum wage (or the legally required minimum salary or overtime pay) for any such pay period, and I agree to this method of compensation. I understand that the client to which I am assigned at all times remains obligated to pay me my regular hourly rate of pay if I am a non-exempt employee and to pay me my full salary if I am an exempt employee even If LWS is not paid by the client to which I am assigned. I have been informed and I agree that if my assignment with any LWS client to which I am assigned ends for any reason, I must report back to LWS within seventy-two (72) hours for possible reassignment and that unemployment benefits may be denied me if I fail to do so. In recognition of the fact that any work injuries which might be sustained by me are covered by state workers' compensation statutes, and to avoid the circumvention of such statutes which might result from suits against the customers or clients of LWS or against LWS based on the same injury or injuries, and to the extent permitted by law, I hereby waive and forever release any rights I might have to make claims or bring suit against any client or customer of LWS or against LWS for damages based upon injuries which are covered under such workers' compensation statutes.

    Client Company Paid Leave Policies and Other Benefits

    In the case that Client Company maintains policies providing paid leave benefits such as vacation, sick leave, PTO, or severance pay, Client Company is solely responsible for paying any accrued benefits under such policies during employment and at the time of termination. LWS does not provide, and has no policy providing, vacation or other paid leave benefits. To the extent paid leave benefits are paid through LWS's payroll to Employee, ii is solely as a payroll service on behalf of Client Company. Similarly, to the extent Client Company provides other benefits pursuant to policies to which LWS is not a party, such as stock options, bonuses, profit sharing, retirement benefits, and so forth, Client Company is solely responsible for providing the benefits prescribed by those policies.

    Paid Sick Leave

    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.

  • Powered by Jotform SignClear
  •  - -
  • Employment Application Continue...

  • Assignment
    If Client Company files any form of bankruptcy, Employee will and hereby transfers to LWS all of his/her rights as a employee for the purposes of
    payment of wages and applicable payroll taxes. For this right, LWS will compensate Employee an additional five percent (5%) premium, on those
    amounts LWS receives from client as a result of the assignment of Employee's rights.

    Policies and Benefits
    Employee agrees to abide by the policies of LWS, including but not limited to policies contained in any applicable Employee Handbook. Employee
    understands that eligibility and coverage for LWSS benefits is controlled by the terms and conditions of the applicable Plan Documents.

    Medical Authorization
    I hereby authorize the release of any and all medical, hospital, vocational and psychological records and other information related to my injury, illness
    or worker's compensation claim (hereinafter collectively referred to as "Medical Information") to LWS Staffing, its employees, agents and authorized
    representatives. I hereby permit LWS to review and obtain copies of any and all Medical Information and to discuss pertinent Medical Information with
    professionals involved in my health care treatment. I hereby give LWS permission to release the Medical Information to healthcare providers, third
    party administrators, federal or state court, Workers' Compensation Boards, employers, insurers and any other party who may be involved with my
    claim, treatment or vocational rehabilitation, or as required by law. Further, pursuant to Title 42 Section 1395y, carriers are required to share
    claimants' Medical Information to enable the Centers for Medicare & Medicaid Services, formerly known as Healthcare Financing Administration (CMS)
    to determine eligibility for benefits. I hereby give LWS Staffing Workforce permission to discuss, disclose and release any Medical Information with or
    to CMS in connection with my claim. I hereby release LWS Staffing from any liability or loss due to the release of any Medical Information. I understand
    that all information released will be handled confidentially and in accordance with all applicable laws. I also understand that this authorization shall
    stay in effect until the closure of the claim file. I certify that this authorization has been made voluntarily and that the information given herein is
    accurate to the best of my knowledge. A photocopy of this authorization shall have the same validity as the original.

    Accident/Injury Guidelines & Procedures
    1. All injuries must first be reported to your immediate supervisor, who will, then report the incident to LWS Workers' Compensation
    Department before authorization will be given for medical treatment. Exception: emergency situations or if the injury occurs after hours
    and/or on the weekends.
    2. A drug screen is required within 24 hours for all injuries. In accordance with state law, a positive result relieves LWS and its insurers from any
    responsibility for any medical expenses incurred in connection with your injury. Refusal to submit to a drug test will result in the same
    consequences as a positive drug test result. If an employee tests positive on a post-accident drug test, they will be discharged for violation of
    the company substance abuse policy, and workers' compensation benefits and/or medical bills incurred by the employee will be denied.
    3. The employee is required to inform the doctor or medical facility that light duty work is available. The employee will be required to work
    light duty per the doctor's instructions.
    4. Employees are required to forward all medical information associated with the work-place injury/illness (doctor's work status report,
    medical records, etc.) within 24 hours of receipt.
    5. Employees are required to complete an Employee Accident/lnjury Report within 24 hours of the injury/illness.

    Substance Abuse Policy
    Any employee on duty or on company property who possesses, sells, receives, or is determined to have measurable levels of any illegal drug, or
    sufficient alcohol to impair performance in their blood or urine, will be subject to immediate discharge, and in appropriate situations, referred to law
    enforcement authorities. See your Employee Handbook regarding procedures applicable to prescriptive medications. Periodically, unannounced
    inspections will be made of persons entering or leaving company worksites by authorized company representatives. Entry onto company property is
    deemed to be consent to an inspection of a person, locker, vehicle, or any other personal effects. LWS also reserves the right to require employee
    testing for illegal or controlled drugs or alcohol, based on reasonable suspicion and I as an employee specifically agree to post- accident drug testing in
    any situation where it is allowed by law.

    Deductions
    By initialing this page below and signing this employment agreement form I authorize deductions when applicable to be made out of my paycheck for
    tools, uniforms, health insurance, errors in payroll, garnishments, overpayments, bank fees for stop payment of a lost or damaged check, and any other
    work-related deductions. I agree that if I should leave or be discharged from employment at (the above client company of LWS) before the full amount
    is paid, any earnings over minimum wage will be applied to my deduction loan. The amount deducted from my last paycheck may be greater than the
    amount shown for each paycheck in accordance with the applicable labor law.

  • Powered by Jotform SignClear
  •  - -
  • Employment Application Continued...

  • Six Hour Meal Period Waiver Agreement
    I, hereby agree, by mutual consent of the employer and employee, to waive my required meal period when a work period of not more than six (6)
    hours will complete the day's work, as defined by the State of California Industrial Welfare Commission Order, Section 11 (A).

    Acknowledgement of Meal & Rest Periods Policy
    This policy details the meal and rest period policy and process for non-exempt employees in California. Pursuant to California law, employees who
    work more than five (5) hours will be provided with at least a full thirty (30) minute meal period. This meal period will begin no later than the fifth hour
    of work. Additionally, employees who work more than ten (10) hours in a workday will provided with a second thirty (30) minute meal period. This
    second meal period must be taken before the end of the tenth hour of work. Meal periods cannot be taken at the beginning or end of shifts.
    Employees will be relieved of all of their duties during meal periods and may not work during this time. An employee's meal period shall not be
    considered "on duty" and will not be counted as time worked. Employees will be provided ten (10) minute paid rest periods to employees for every
    four (4) hours worked or major fraction thereof, unless the employee works less than three and a half hours in a day. Employees will be informed by a
    supervisor when to take their rest periods. Whenever practicable, employees should be able to take their rest breaks near the middle of each four
    hour work period. Employees may not accumulate rest periods or use rest periods as a basis for starting work late, leaving their assigned shift early, or
    extending a meal period. Because rest breaks are paid, employees should not clock out for them. This meal and rest break policy applies at all times
    during your employment, including while placed on job assignment at any client company in California.

    I hereby certify that I fully understand this policy and process regarding meal and rest periods and will comply with these rules. If I miss or am
    unable to take a meal or rest period, I agree to notify my local branch office within twenty-four (24) hours so that my employer can investigate and
    take the appropriate corrective action.

    Harassment, Discrimination and Retaliation Prevention Policy
    Reporting Harassment or Discrimination - If you believe that you have been subjected to or witnessed any unlawful harassment, discrimination, or
    retaliation, you should immediately report such conduct to your supervisor. If you do not feel comfortable reporting harassment or discrimination to
    your supervisor, you should report the harassment and/or discrimination to LWS Human Resources Employee. In addition, if an employee observes
    harassment or discrimination by another employee, supervisor, manager, or nonemployee, the employee should immediately report the incident to
    the Human Resources Department.
    Employees' notification to LWS is essential to enforcing this policy. Employees may be assured that they will not be penalized in any way for reporting a
    harassment or discrimination problem. It is unlawful for employers to retaliate against employees who oppose practices prohibited by the California
    Fair Employment and Housing Act ("FEHA"), or who file complaints or otherwise participate in an investigation, proceeding, or hearing conducted by
    the California Department of Fair Employment and Housing ("DFEH") or the Fair Employment and Housing Commission ("FEHC"). Similarly, LWS
    prohibits employees form hindering its internal investigations or its internal complaint procedure.
    All complaints of unlawful harassment or discrimination that are reported to management or to the Human Resources Department will be investigated
    as promptly as possible through a fair and thorough investigation by an impartial qualified LWS representative. LWS will conduct its investigation in a
    manner that provides all parties appropriate due process and reasonable conclusions that are based on the evidence collected, including by
    documenting and tracking its investigation. Corrective action will be taken where warranted and based on the documented evidence.
    All complaints of unlawful harassment or discrimination will be treated with as much confidentiality as possible, consistent with the need to conduct an
    adequate investigation.
    Supervisors and/or managers who witness harassment, discrimination, or retaliation, or who receive reports of harassment, discrimination, or
    retaliation, must immediately report such conduct to the Human Resources Department. Failure to do so for supervisors and/or managers may result
    in disciplinary action.

    Violations of this Policy
    Violation of this policy will subject an individual to disciplinary action, up to and including immediate termination. Additionally, under California law,
    employees may be held to be personally liable for harassing conduct that violates the FEHA.

    Retaliation Prohibited
    LWS prohibits retaliation against those who report, oppose or participate in an investigation of alleged violations of this policy. Participating in an
    investigation of alleged wrongdoing in the workplace includes:
         1. Filing a complaint with a federal or state enforcement or administrative agency.
         2. Participating in or cooperating with a federal or state enforcement agency that is conducting an investigation of the company regarding
    alleged unlawful activity.

  • Powered by Jotform SignClear
  •  - -
  • Employment Application (Continued...)

  • Harassment, Discrimination and Retaliation Prevention Policy Continued
    Retaliation Prohibited Continued
    3. Testifying as a party, witness or accused regarding alleged unlawful activity.
    4. Associating with another employee who is engaged in any of these activities.
    5. Making or filing an internal complaint with the company regarding alleged unlawful activity.
    6. Providing informal notice to the company regarding alleged unlawful activity. LWS strictly prohibits any adverse action or retaliation against
    an employee for participating in an investigation of alleged violation of this policy. If an employee feels that he or she is being retaliated
    against, the employee should immediately LWS Human Resources Employee. In addition, if an employee observes retaliation by another
    employee, supervisor, manager or nonemployee, he or she should immediately report the incident to the individuals above.

  • Worker's Compensation Information

  • Powered by Jotform SignClear
  •  - -
  • Employment Application Continued...

  • Acceptance of Requirement Agreement

  • Image-192
  • Powered by Jotform SignClear
  •  - -
  • Employment Application Continued...

    Safety Policy and Procedures
    • Arrive to work with a serious behavior and attitude towards safety in the work environment.
    • Any negative behavior or attitude such as horse playing is unacceptable and will not be tolerated.
    • Always follow the safety practices and procedures, any negligence is unacceptable and will not be tolerated.
    • Make sure that you are wearing the appropriate Personal Protective Equipment (PPE) for the job that you are assigned. If you are unsure
      what PPE you are supposed to use, please ask your supervisor immediately before you begin to work. Failure to wear appropriate PPE is
      unacceptable and will not be tolerated.
    • Always be a defensive Employee and look out for hazards. If you feel that you are exposed to a hazard please contact your supervisor at
      once, if supervisor is not available please contact your employment agency representative.
    • Remember that each and every one of you is part of the safety team at Labor Work Solutions, and it’s your responsibility to report accidents,
      incidents and/or injuries immediately.
    • In the event of an accident, injury and/or incident please follow the emergency protocol designated by your place of work.
    • If any Employee sustains any injury at work or on Employers premises during working hours, the employee is required to report such injury
      to the Employer within 24 hours after the injury. Failure to report the accident within the time limit is unacceptable will not be tolerated.
  • By signing below, I,      , the Employee, confirm that I have read and understood all of the above Safety Policies and Procedures. I understand that if I do not follow the Safety Policies and Procedures above, corrective action will be taken against me, the Employee, with a warning that could lead to disciplinary action up to and including termination.      

  • Powered by Jotform SignClear
  •  - -
  • By signing below, I,   , the Employee, confirm that I have read and understood all of the above Safety Policies and Procedures. I understand that if I do not follow the Safety Policies and Procedures above, corrective action will be taken against me, the Employee, with a warning that could lead to disciplinary action up to and including termination. 

  • Powered by Jotform SignClear
  •  - -
  • W-4 Employee Withholding Form (2025)

  • Step 1: Enter Personal Information

  • 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)  Use the estimator at www.irs.gov/W4App for the most accurate withholding for this step (and Steps 3–4). If

    you or your spouse have self-employment income, use this option; or
    (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 . . . . . . . . . . . . . . . . . .

    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: Claim Dependent and Other Credits

  • Step 4 (optional): Other adjustments

  • 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.
  • Powered by Jotform SignClear
  •  - -
  • Employee Eligibility Verification

    Department of Homeland Security U.S. Citizenship and Immigration Services
  • 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.

     

    note: instructions can be found on https://www.uscis.gov/sites/default/files/document/forms/i-9instr.pdf

  •  - -
  • If you have checked "An alien authorized to work until" then enter one of these:

  • Powered by Jotform SignClear
  •  - -
  • Section 2. Employer Review and Verification

    Employers of 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 any alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and C. Enter any additional documentation in the Additional Information Box; see Instructions.
  • Image-257
  • Should be Empty: