PERSONAL INFORMATION



LABOR DATA



PREVIOUS U.S. MILITARY


AVAILABLE TO WORK FROM


WORK SKILLS: CHECK THE SKILLS AND KIND OF WORK YOU HAVE DONE


PREVIOUS EMPLOYMENT

1st EMPLOYMENT

2st EMPLOYMENT

s

3st EMPLOYMENT

EDUCATION

1st SCHOOL

2st SCHOOL

3st SCHOOL

PROFESSIONAL REFERENCES:

1st REFERENCE

2st REFERENCE

3st REFERENCE

EMPLOYMENT AUTHORIZATION AND ACKNOWLEDGEMENT

Employment: I understand my Worksite Employer entered into an agreement with J&LWWS or an affiliated company (J&LWWS) whereby J&LWWS has agreed to provide certain specifically identified emplyment related services for me and my Worksite Employer. I understand my Worksite Employer will manage, direct and control day-to-day activities, and i remain an at-will leased employee. Employment is on a probationary basis the first ninety (90) days after hiring.

Acknowledgment/Disclaimer of Employment Status: I understan i will NOT be considered a J&LWWS employee for any purpose until a completed New Employee Packet and paperwork is fully COMPLETED and RECEIVED by J&LWWS.

Wages: I acknowledge my Worksite Employer is responsible for paying my wages. In the event my Worksite Employer does not pay J&LWWS for services provided by me to my Worksite Employer for a particular pay period, J&LWWS may terminate the Agreement with th Worksite Employer, with no further obligations to me or my Worksite Employer. If the Agreement with my Worksite Employer remains in place, J&LWWS may terminate my employment with no further obligations, or may elect to pay me for such pay period no more than the then-current minimum wage rate and my applicable overtime pay based on such minimum wage rate or the minimum salary for that pay period, as permitted by law. I understand my worksite Employer remains ultimately obligated to me for any unpaid wages i may be due. In the event my Worksite Emplyer files a petition in bankruptcy at a time when monies are due to J&LWWS from my Worksite Employer for wages paid to me, I hereby assign J&LWWS any and all rights i have to assert a priority wage claim in the bankruptcy proceeding. I also authorize J&LWWS and its affiliates to initiate any adjustments on future wages for any entries made in error.

Unemployment: I hereby agree to notify J&LWWS in the event i resign or am terminated by my Worksite Employer, regardless of the reason within 48 hours for possible reassignment and unemployment benefits may be denied if i fall to do so.

Safety/Injuries: I agree to immediately report to J&LWWS and my Worksite Employer any accidents or injuries i suffer while working or while my Worksite Employer's premises. I further agree to follow all safety rules and regulations established by elther J&LWWS or my Worksite Employer and realize that failure to do so may alter any workers compensation benefits provided to me. In recognition of the fat that any work related injurles witch might be sustained by me are covered by state Workers compensation statutes, and to avoid the circumvention of such state statutes which may result in suits against the customers or clients of J&LWWS based on the same injury or injuries, and to the extent permitted by law, I hereby wave and forever release any rights i might have to make claims or bring suits against any client or customer of J&LWWS for damagese based upon injurles covered under Workers' Compensation statutes.

Drug Testing: I understand J&LWWS or my Worksite Employer may now have, or may establish, a drug-free workplace or a drug and/or alcohol testing program consistent with applicable federal, state, or local law. I understand that, pursuant to the Worksite Employer's policy and federal, state, or local law, i may, as a condition of hire or continued employment, by subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. I also undestand i may be subject to an alcohol and/or drug test before any teatment of a work-related accident or injury. I understand that refusal to submit to an alcohol and/or drug test may be considered a positive test result and/or grounds for termination.

Background Check: I understand all information contained in this New Employee Packet is subject to verification. In the event my Worksite Employer requires a complete background and/or credit check, i authorize and consent, to the extent permitted by federal, state, and local law, to allow my Worksite Employer, J&LWWS, or their respective agent(s) to obtain information including, buy not limited to, motor vehicle reports (driving records), credit history, employment or educational references, criminal history, and any other information concerning me.

Duty to Report Harassment: J&LWWS does not and will not tolerate harassment of or discrimination against employers, applicants, customers or vendors. All J&LWWS employees are strictly prohibited from engaging in any from of harassing and/or discriminatory conduct. If you think you are being harassed or discriminated against by a other employee, manager, customer, or vendor, you should promptly notify the Worksite Employer's President and the Human Resource Department at J&LWWS, 7130 s Orange Blossom Trail Orlando, FL 32809; telephone (407) 692-4239 and (407) 558-5687 whereupon the matter will be discreetly and thoroughly investigated. Immediate steps will be taken to stop any improper behavior. Disciplinary action, up to and including termination of employment, will be taken, when appropriate, against the offender(s). I agree if at any time during my employment i am subject to any type of discrimination, including buy not limited to discrimination because of race, sex, including same-sex, secual orientation, pregnacy, age, religion, color, military status, veteran status, national origin, citizenship, handicap, disablility, or marital status, or if i am subject to any type of harassment, including buy not limited to sexual harassment, or any other treatment which i believe is unfair or improper, i will im mediately contact the Worksite Employer's president and the Human Resource Department at J&LWWS, TELEPHONE (407) 692-4239 AND (407) 558-5687, in order to abtain assistance in the resolution of such matters.

Authorizing Release: I hereby authorize any party or agency contacted by my Worksite Employer, J&LWWS, or their respective agent(s) to furnish information requested. I understand i may be to complete additional releases authorizing my Worksite Employer or its agents to investigate all statements contained in this or any other employment related documents. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, or local law, my Worksite Employer, J&LWWS, their respective agent(s), and any party delivering information to them pursuant to this authorization from any liabilities, claims, charges, or cause of action that i may have a resolt of gathering delivery or disclosure of any requested information.

EMPLOYEE CERTIFICATION

I hereby certify all information contained in these New Employee Packet or in any other application, resume, or document provided to my Worksite Employe or J&LWWS is true, accurate and complete, and is provided knowiingly and voluntarily. I understand that providing any false, inaccurate, or incomplete information may result in disciplinary action, up to and including termination of my employment.

DIRECT DEPOSIT/PREPAY CARD

AUTHORIZATION FOR DIRECT DEPOSIT/PREPAY CARD



A voided check or documentation from your financial institution must be attached for your request to be processed!





By prociding the information requested above and signing below, I here by elect and consent to receive my wages, including but not limited to off cycle wage payments and wage payments upon discharge, by electronic transfer of wages to a pay card. In addition, to the extent permitted by applicable law, i here by authorize J&LWWS to make all of my deposits and deposit adjustments, including those involving off-cycle wage payments and wage payments upon discharge, to my authorize the bank where such funds are deposited to accept such deposits and make such adjustments. I acknowledge i have received a copy of the terms and fees associated with using such pay card. This authorization shall remain in effect fourteen (14) day after J&LWWS has been notified to terminate my authorization.

*First transaction is free after each pay day. This allows you to remove all available funds at no cost.

WORKER COMPENSATION FRAUD POLICY

It is J&LWWS's policy to support workers' compensation laws and systems. Web are absolute proponents of Workers Compensation for the legitimately injured employee and will work to help any J&LWWS employee injured on the job to receive appropriate medical treatment and is helped to return to work as quickly as possible. It is also J&LWWS's policy to prosecute to the fullest extent of the law any individual who is found to be committing workers' compensation fraud or collaborating with individuals attempting to defraud the workers'compensation system. J&LWWS willcooperate in the successful prosecution of anyone engaged in Workers' compensation fraud. It is understood by the employee and employer alike, that workers' compensation fraud can be punishable by heavy fines and event jail time.

J&LWWS provides all employees who experience an on the job injury or illness with workers' compensation insurance coverage. This insurance applies to all J&LWWS employees regardless of whether they are full-time, part-time or temporary Workers'compensation coverage procides and employee injured on the job with payment of related medical expenses and partial salary continuation (ad mandated by state law). J&LWWS has a preferred provider network to furnish medical treatment for work-related injuries. J&LWWS has a mandatory Return to Work program for employees who have been released to work by their medical provider to light or restricted duty. The HR Department of J&LWWS, in cooperation with the Branch Managers, coordinates all aspects of the transitional Return to Work Program. Temporary work assignments may be offered when available and tailored to the individual physical capabilities of each injured employee until they are medically stable or have reached Maximum Meidcal Improvement. And injured employee will only be asked to perform those job functions their medical provider determined as safe and appropriate. It is the injured employee's responsibility to keep and schedule any physical therapy and follow up meidcal appointments related to the on the job injury. J&LWWS strives to reduce workplace hazards and eliminate on the job injuries by maintaining a safe workplace and encouraging safe workplace practices.

You are wear safety equipment, if the assignment requires it. If injury occurs and you were not wearing your safety equipment, your workers' compensation may be denied.

use of drugs or alcohol is a major cause of workplace accidents and injuries. Positive drug/alcohol tests may result in termination of Employment and denial of any benefits.

Horseplay is prohibited in the workplace. Workers' compensation benefits may be denied for injuries that occur as a result of horseplay. By signing this document you agree that: You have read and understand J&LWWS policies regarding workers' compensation and Return to Work program and you will adhere to all safety policies and procedures.

WORKERS COMPENSATION BENEFITS

In order to receive workers compensation benefits, you need to know and to follow the rules and obligations of the workers' compensation system. The rules include, but are not limited to:
  • Your injury must be proven to have been job related, occurring in the course of your work and because of it.
  • You must IMMEDIATELY report any and all injuries that occur while you are at work to your J&LWWS representative.
  • Workers' compensation claimants MUST submit to a 10 panel post-accident drug-screen.
  • If you are receiving any type of disability compensation as a result of a workers' compensation claim, you must notify the insurer of any and all employment, social security, cash or unemployment compensation (including income-in-kind).
  • If you do not report earned income while collecting disability benefits, your benefits could be discontinued.
  • Any person knowingly providing false or misleading information in a claim for workers' compensation benefits will be immediately terminated and may be subject to criminal prosecution.
  • If you have questions about your benefits of the above rules, Contact JLWWS Safety and Risk Management Team.

I hereby certify all information contained in these New Employee Packet or in any other application, resume, or document provided to my Worksite Employer or J&LWWS is true, accurate and complete, and is provided knowingly and voluntarily. I understand that providing any false, inaccurate, or incomplete information may result in disciplinary action, up to and including termination of my employment.





Form W-4 (2018)

Future developments. For the latest information about any future developments related to Form W-4, such as legislation enacted after it was published, fo to www.irs.gov/FormW4.

Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. You may claim exemption from withholding for 2018 if both of the following apply.

  • For 2017 you had a right to refund of all federal income tax withheld because you had no tax liability, and

  • For 2018 you expect a refund ofall federal income tax withheld because you expect to have no tax liability.

    • If you're exempt, complete only lines 1, 2, 3, 4 and 7 and sign the form to validate it. Your exemption for 2018 expires February 15, 2019. See Pub. 505, Tax withholding and Estimated Tax, to learn more about whether you qualify for exemption from withholding.

    General Instructions

    If you aren't exempt, follow the rest of these instructions to determine the number of withholding allowances you should claim for withholding for 2018 and any additional amount of tax to have withheld. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

    You can also use the calculator at www.irs.gov/W4App to determine your tax withholding more accurately.

    Consider using this calculator if you have a more complicated tax situation, such as if you have a working spouse, more than one job, or a large amount of nonwage income outside of your job. after your Form W-4 takes effect, you can also use this calculator to see how the amount of tax you're having withheld compares to your projected total tax for 2018. If you use the calculator, you don't need to complete any of the worksheets for Form W-4.

    Note that if you have too much tax withheld, you will receive a refund when you file your tax return. If you have too little tax withheld, you will owe tax when you file your tax return, and you might owe a penalty. Filers with multiple jobs or working spouses. If you have more than one job at a time, or if you're married and your spouse is also working, read all of the instructions including the instructions for the Two-Earners/Multiple Jobs Worksheet before beginning.

    Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated tax for Individual. Otherwise, you might owe additional tax. Or, your can use the Deductions, Adjustments, and Other Income Worksheet on page 3 or the calculator at www.irs.gov/W4App to make sure you have enough tax withheld from your paycheck. If you have pension or annuity income, see Pub. 505 or use the calculator at www.irs.gov/W4App to find out if you should adjust your withholding on Form W-4 or W-4P.

    Nonresident alien. If you're a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, be fore completing this form.

    Specific Instructions

    Personal Allowances Worksheet

    Complete this worksheet on page 3 first to determine the number of withholding allowances to claim.

    Line C. Head of household please note: Generally, you can claim head of household filing status on your tax return only if you're unmarried and pay more than 50% of the costs of keeping up a home for yourself and a qualifying individual. See Pub. 501 for more information about filing status.

    Line E. Child tax credit. When you file your tax return, you might be eligible to claim a credit for each of your qualifying children. To qualify, the child must be under age 17 as of December 31 and must be your dependent who lives with you for more than half the year. To learn more about this credit, see Pub. 972, Child Tax Credit. To reduce the tax withheld from your pay by taking this credit into account, follow the instructions on line E of the worksheet. On the worksheet you will be asked about your total income. For this purpose, total income includes all of your wages and other income, including income earned by a spouse, during the year.

    Line F. Credit for other dependents. When you file your tax return, you might be eligible to claim a credit for each of your dependents that don't qualify for the child tax credit, such as any dependent children age 17 and older. To learn more about this credit, see Pub. 505. To reduce the tax withheld from your pay by taking this credit into account, follow the instructions on line F of the worksheet. On the worksheet, you will be asked about your total income. For this purpose, total income includes all of







    I claim the retention exemption for 2018, and certify that I meet the following conditions for the exemption.

  • Last year I was entitled to a refund of all federal income taxes withheld because I had no tax liability, and
  • This year I expect a refund of all federal income taxes withheld because I hope I have no tax liability. If you meet both conditions, write "Select exempt" hereThis year I expect a refund of all federal income taxes withheld because I hope I have no tax liability.








    • ► START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.

    ANTI-DISCRIMINATION NOTICE:

    It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

    Section 1. Employee Information and Attestation

    (Employees must complete and sign Section 1 of Form 1-9 no later than the first day of employment, but not before accepting a job offer.)

    I attest, under penalty of perjury, that I am (check one of the following boxes):

    Preparer and/or Translator Certification (check one):

    I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.:

    List A

    Identity and Employment Authorization

    ===================================================
    ===================================================

    List B

    Identity

    List C

    Employment Authorization




    Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear 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.




    Section 2. Employer or Authorized Representative Review and Verification

    (Employers or their authorized representative must complete and confirm Section 2 within 3 business days of the employee's first day of employment. must physically examine a document from List A or a combination of a document from List B and a document from List C as indicated in the "Lists of Acceptable Documents ".

    TRUE OR FALSE (Select the correct answer)




    FILL IN THE BLANK


    HAZARD COMMUNICATION (The Right to Know Law)




    TRUE OR FALSE (Select the correct answer)



    By signing below, I acknowledge that I have watched the J&L WORLDWIDE SOLUTIONS Safety Orientation Video in full and do understand the material as it has been presented. I also understand that I will report any injury, no matter how minor, to my Supervisor and J&LWWS immediately.


    Please sign below