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STAFFING, INC. EMPLOYMENT APPLICATION · Pre-Employment Background Check Disclosure & Authorization...

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Certification and Acknowledgement. I hereby declare that the information I have provided is complete and true to the best of my knowledge. I understand and agree that any false information, omission, or misrepresentation discovered at any time can result in rejection of my application or termination of employment. Employment Opportunity AUE Staffing, Inc. is an Equal Opportunity Employer; all qualified applicants will receive consideration without regard to gender, marital status, race, color, age, creed, religion, national origin, veteran status or disability. Background Investigation I hereby authorize AUE Staffing, Inc. to investigate my background inclusive of any criminal records. Drug use and Testing AUE Staffing, Inc. is a drug free work environment and I understand that I am subject to a drug and /or alcohol test prior to acceptance of a job offer and if there is any reason whatsoever to suspect drug or alcohol use. I understand that company policy requires a drug and alcohol test whenever there is an on the job accident or injury. I hereby authorize and consent to all such tests and acknowledge my understanding that a positive drug tests or refusal to submit to a required drug test will result in my dismis- sal. I hereby release AUE Staffing, Inc., its clients and any clinic, individual or test product manufacturer that administers or provides such tests from any and all claims arising out of the results of such a tests. Release of Information I authorize AUE Staffing, Inc., all former employers, and others given by me as reference to answer all questions and to give any information concerning me. I authorize AUE Staff- ing, Inc. to disclose the information contained herein and its findings and work history of my employment to other firms or persons upon request. NAME OF EMPLOYER PHONE & ADDRESS SUPERVISOR DOES COMPANY USE TEMP WORKERS PAY / HOUR POSITION REASON FOR LEAVING YES NO YES NO YES NO MO/YR MO/YR PREVIOUS EMPLOYMENT FROM TO TEMPORARY AGENCY COMPANY ASSIGNED POSITION PAY RATE SUPERVISOR HAVE YOU EVER WORKED FOR A TEMPORARY SERVICE. IF YES, PLEASE LIST LAST POSITION FIRST SIGNATURE NAME NAME PHONE YEARS KNOWN REFERENCES EMPLOYMENT APPLICATION AUE STAFFING, INC. LAST NAME FIRST NAME M.I. SURNAME NICKNAME SOCIAL SECURITY NO ADDRESS CITY STATE ZIP HOME TELEPHONE ALT TELEPHONE CELL PHONE EMAIL ADDRESS OK TO TEXT? YES NO CELL PHONE PROVIDER (IF KNOWN) DO YOU HAVE LEGAL WORK STATUS TO WORK IN THE U.S.? YES NO POSITION(S) APPLYING FOR DATE AVAILABLE TO WORK MINIMUM RATE PER HOUR $ ___________________ / HR WOULD LIKE TO WORK I AM OVER 18 YEARS OLD NAME OF EMERGENCY CONTACT RELATIONSHIP TELEPHONE HOW DID YOU HEAR ABOUT US? HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES NO PartͲTime FullͲTime DAYS AVAILABLE TO WORK MON TUE WED THU FRI SAT SUN SHIFT PREF HOURS AVAILABLE TO WORK FROM: HAVE RELIABLE TRANSPORTATION WILL ACCEPT SAME DAY ASSIGNMENT AVAILABLE LONG TERM ASSIGNMENT TEMP TO HIRE OK DIRECT HIRE OK RESUME ATTACHED AM PM AM PM 1 st 2 nd 3 rd 1 st 2 nd 3 rd 'DWH 'DWHBBBBBBB
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Certification and Acknowledgement. I hereby declare that the information I have provided is complete and true to the best of my knowledge. I understand and agree that any false information, omission, or misrepresentation discovered at any time can result in rejection of my application or termination of employment. Employment Opportunity AUE Staffing, Inc. is an Equal Opportunity Employer; all qualified applicants will receive consideration without regard to gender, marital status, race, color, age, creed, religion, national origin, veteran status or disability. Background Investigation I hereby authorize AUE Staffing, Inc. to investigate my background inclusive of any criminal records. Drug use and Testing AUE Staffing, Inc. is a drug free work environment and I understand that I am subject to a drug and /or alcohol test prior to acceptance of a job offer and if there is any reason whatsoever to suspect drug or alcohol use. I understand that company policy requires a drug and alcohol test whenever there is an on the job accident or injury. I hereby authorize and consent to all such tests and acknowledge my understanding that a positive drug tests or refusal to submit to a required drug test will result in my dismis-sal. I hereby release AUE Staffing, Inc., its clients and any clinic, individual or test product manufacturer that administers or provides such tests from any and all claims arising out of the results of such a tests. Release of Information I authorize AUE Staffing, Inc., all former employers, and others given by me as reference to answer all questions and to give any information concerning me. I authorize AUE Staff-ing, Inc. to disclose the information contained herein and its findings and work history of my employment to other firms or persons upon request.

NAME OF EMPLOYER PHONE & ADDRESS SUPERVISOR DOES COMPANY USE TEMP WORKERS

PAY / HOUR

POSITION REASON FOR LEAVING

���YES����������NO

���YES����������NO

���YES����������NO

MO/YR MO/YR

PREVIOUS EMPLOYMENT

FROM TO TEMPORARY AGENCY COMPANY ASSIGNED POSITION PAY RATE SUPERVISOR

HAVE YOU EVER WORKED FOR A TEMPORARY SERVICE. IF YES, PLEASE LIST LAST POSITION FIRST

SIGNATURE

NAME

NAME PHONE YEARS KNOWN

REFERENCES

EMPLOYMENT APPLICATION

AUE STAFFING, INC.LAST NAME FIRST NAME M.I. SURNAME NICKNAME SOCIAL SECURITY NO

ADDRESS CITY STATE ZIP HOME TELEPHONE ALT TELEPHONE CELL PHONE

EMAIL ADDRESS OK�TO�TEXT?������YES��������������NO�

CELL PHONE PROVIDER (IF KNOWN) DO YOU HAVE LEGAL WORK STATUS TO WORK IN THE U.S.? ��YES��������NO�

POSITION(S) APPLYING FOR DATE AVAILABLE TO WORK MINIMUM RATE PER HOUR

$ ___________________ / HR WOULD LIKE TO WORK ����I�AM�OVER�18�

YEARS�OLD�

NAME OF EMERGENCY CONTACT RELATIONSHIP TELEPHONE HOW DID YOU HEAR ABOUT US? HAVE YOU EVER BEENCONVICTED OF A FELONY? ����YES��������NO��

�PartͲTime�����FullͲTime�DAYS AVAILABLE TO WORK

�����������������������������������������������������������������MON TUE WED THU FRI SAT SUN�

SHIFT PREF HOURS AVAILABLE TO WORK FROM: ���HAVE�RELIABLE�TRANSPORTATION������WILL�ACCEPT�SAME�DAY�ASSIGNMENT� ����������AVAILABLE�LONG�TERM�ASSIGNMENT�

���TEMP�TO�HIRE�OK����DIRECT�HIRE�OK����RESUME�ATTACHED�

����AM�������PM�

����AM��������������������PM�������������������

��1st���2nd���3rd�

��1st���2nd���3rd

'DWH

'DWHBBBBBBB

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HIGH SCHOOL NAME YEARS ATTENDED ��1���������2���������3���������4�

GRADUATED��YES���������������NO�

COURSE OF STUDY

HIGHER EDUCATION— College, Trade, Business School

SKILLED � FACTORY MAINTENANCE WAREHOUSE EQUIPMENT DRIVER SUPPLIES AVAIL

���Carpenter� ���ConstrucƟon� ���Mech�Assembler� ���Building�Repair� ���Computer�Skills� ���Backhoe� ���License� ���Hard�Hat����Electrician� ���Painter� ���Elec�Assembler� ���Machinery�Repair� ���Receiving� ���Bulldozer� � ���Tools����Plumber� ���Flagger� ���PC�Board�Assembler� ���Floor�Care� ���Shipping� ���Outside�ForkliŌ� ���CDL—A� ���Safety�Glasses����HVAC� ���Mover� ���Solderer� ���Landscape� ���Load/Unload� ���Crane� ���CDL—B� ���Steel�Toe��Boots����Welder� ���Laundry� ���Inspector� ���Lawncare� ���Hand�Jack� ���Drill� ���CDL—C� ���Fluorescent�Vest����Machinist� ���Road�Crew� ���Picker/Packer� ���Hotel�Cleaning� ���ForkliŌ� ���Saw� ���Tractor�Trailer� ���Gloves����DemoliƟon� ���Digger/Raker� ���Quality�Control� ���Janitorial� ����Stand�Up� ���Nail�Gun� ���Delivery�Truck� ���_____________����Supervisor� ���General�Labor� ���Machine�Operator� ���_____________� ����Sit�Down� ���Jack�Hammer� ���Delivery�Van� ���_____________����Mechanic� ���Millwright� ���ProducƟon�Line� ���_____________� ����Cherry�Picker� ���_____________� ���AutomaƟc� ���_____________����___________� ���Concrete� ���ProducƟon�Cell� ���_____________� ���Inventory� ���_____________� ���Clutch� ���_____________����___________� ��____________� ���_________________� ���_____________�

���Order�Selector� ���_____________� ���____________� ���_____________�

INDUSTRIAL SKILLS - Please check all that apply

ADMIN ASST RECEPTIONIST EQUIPMENT BOOKKEEPING SOFTWARE

���General� #�in�Lines�_______� ���Typewriter�� ���Full�Charge�� ���MS�Access����Medical� #�in�Ext�����_______����Copier� ���Assistant�� ���MS�Excel����Legal� ���Switchboard� ���Fax�� ���Accts�Payable�� ���MS�Outlook����MarkeƟng� ���Headphone� ���Postage�Meter� ���Accts�Receivable� ���MS�Powerpoint����Manufacturing� ��____________� ���Calculator� ���CollecƟons� ���MS�Word����Financial� ��____________� ���Projector� ���Payroll� ���Lotus�1Ͳ2Ͳ3�OFFICE ��____________� ���Computer�� ���Tax�PreparaƟon� ���Peachtree�Acctg����Customer�Service� � ���Email�� ���SoŌware� ���Quickbooks����TelemarkeƟng—In� � ���Internet� ���Manual� ���Windows����TelemarkeƟng—Out� � ���Scanner� ���Budget�Analysis� ���Word�Perfect����Filing� � ���PDA� ���AudiƟng� ���Web�Design����Mail�Room� � � ���Invoicing� ���Photo�EdiƟng����_________________� � � � �

CLERICAL SKILLS - Please check all that apply

FOOD SERVICE OTHER

���Server� ���Work�in�schools�with�children����Bartender� ���School�Custodian����Cook� ���Bilingual�(English/Spanish)����Prep�cook� ���Ability�to�liŌ�50�pounds����Dishwasher� ���SubsƟtute�Teacher����School�Cafeteria� ���___________________________����Cashier� ���___________________________����Hostess� ���___________________________����Baker� ���___________________________����_______________� ���___________________________����_______________� ���___________________________����_______________� ���___________________________����_______________� ���___________________________�

OTHER SKILLS - Please check/list all that you have done

I understand this form is for use in evaluating my qualifications for employment and is not an offer or promise of employment. An interview, background investigation, drug test, skills assessment and policy review is required before any final determination of my suitability for employment is made. I understand it is my responsibility to notify AUE Staffing, Inc. of my availability on a weekly basis at a minimum or at the end of an assignment. If I do not, I will be considered unavailable for work.

SIGNATURE

PRINTED NAME SIGNATURE DATE

AUE STAFFING, INC. SKILLS ASSESSMENT

SELECTION�FOR�PAYCHECK�DELIVERY�METHOD�

YOU�HAVE�THE�OPTION�OF�RECEIVING�YOUR�PAYCHECK�VIA�DIRECT�DEPOSIT�OR�VIA�PAY�CARD.�

� PAYCARD,�I�do�not�want�direct�deposit

� DIRECT�DEPOSIT,�I�do�not�want�a�pay�card.��My�account�information�and�voided�check�are�provided.��I�understand�Direct�Deposit�may�take�up�to�a�week�to�be�in�effect.����������

� � � � � � � �

AUTHORIZATION�AGREEMENT�FOR�AUTOMATIC�DEPOSIT�

��

A�VOIDED�CHECK�OR�OFFICIAL�BANK�DOCUMENT�MUST�BE�ATTACHED�TO�THIS�FORM�

____________________________________________�� � __________________�Signature� � � � � � � � Date

I hereby authorize AUE Staffing, Inc. to initiate credit entries and to initiate, if necessary, debit entries and adjustment for any credit entries in error to my checking or savings account indicated above and the bank/depository named above to credit and/or debit the same to such account.

Pre-Employment Background Check Disclosure & Authorization Form

In connection with my application for employment (including contract for services or volunteer services) or tenancy with _______________________. These consumer reports (investigative consumer reports in California) may include the following types of information: names and dates of previous employers, salary, work experience, education, accidents, licensure, credit (except California), etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, workers’ compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records. In addition, investigative consumer reports as defined by the federal Fair Credit Reporting Act, gathered from personal interviews with former employers and other past or current associates of mine to gather information regarding my work performance, character, general reputation and personal characteristics may be obtained. I have the right to make a request to the consumer-reporting agency: INTELIFI, Inc. 8730 Wilshire Blvd, Suite 412, Beverly Hills, California 90211; telephone (888) 409-1819 (“Agency”) , upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information and the agency, on our behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by the investigative consumer report(s); and the recipients of any reports on me which the agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to your obtaining the above information from the agency. You may view our privacy policy at our website: www.intelifi.com . I hereby authorize procurement of consumer report(s) and investigative consumer report(s).If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period. California, Minnesota and Oklahoma Applicants: Check box if you request a copy of your consumer report Notice to California Residents: You have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (PTZ) Monday through Friday) to obtain all information in your file for your review. You may obtain such information as follows: 1) In person at the Agency’s offices, which address is listed above. You can have someone accompany you to the Agency’s offices. Agency may require this third party to present reasonable identification. You may be required at the time of such visit to sign an authorization for Agency to disclose to or discuss your information with this third party; 2) By certified mail, if you have previously provided identification in a written request that your file be sent to you or to a third party identified by you; 3) By telephone, if you have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in your file to you and if the file contains any information that is coded, such will be explained to you. Notice to New York Residents: I acknowledge receiving a copy of Article 23A of the NY Correction Law I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE CONSUMER REPORTING AGENCY TO FURNISH THE ABOVE-MENTIONED INFORMATION. I acknowledge that I have been provided a copy of consumer’s rights under the Fair Credit Reporting Act. __________________________________ __________-______-_________ _______/_______/______ Print Name Social Security # Date of Birth _______________________________________ _______/_______/_______ Applicant’s Signature Date ____________________________________________________ ________________________________________ Email (required in order to receive legal notices) Any other names used

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AUE STAFFING, INC
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AUE STAFFING, INC SEXUAL HARASSMENT POLICY

It is policy of AUE Staffing, INC to prohibit sexual harassment of one employee by another employee, supervisor, attorney, or third party. Conduct considered being sexual harassment includes:

• Verbal statements or physical conduct of a sexual nature • Unwelcome sexual advance or proposition • Display in the workplace of sexually suggestive or explicit objects or pictures

Verbal statements or physical conduct of a sexual nature is unlawful (1) if such behavior creates a hostile or offensive environment (2) if submission to such conduct is either explicitly or implicitly made a term or condition of employment or a basic of any employment decision affecting the individual. Any employee, who believes that he or she has been the subject of any form of sexual harassment, should report the alleged act immediately to AUE Staffing, INC On-Site Supervisor or AUE Staffing, INC Human Resource Department. No management personnel, supervisor, or other employee shall place an employee at a disadvantage or retaliate against an employee for having reported a complaint of sexual harassment. Any retaliation will result in disciplinary action. All complaints of sexual harassment will be investigated and the employee will be advised of the findings and conclusion. All actions taken to resolve complaints of harassment through internal investigations shall be conducted confidentially. Any supervisor or employee who is found, after appropriate investigation, to have engaged in sexual harassment of another employee will be subject to appropriate disciplinary action depending upon the circumstances, up to and including termination.

I have read and understand the above mentioned policy and will adhere to this policy.

Employee: _____________________________ Date: ___________________ Witness: _____________________________ Date: ____________________

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USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

Employment Eligibility Verification Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 11/14/2016 N Page 1 of 3

►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 I-9 no later than the first day of employment, but not before accepting a job offer.)Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)

Address (Street Number and Name) Apt. Number City or Town State ZIP Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number

- -

Employee's E-mail Address Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident

4. An alien authorized to work until (See instructions)

(expiration date, if applicable, mm/dd/yyyy):

(Alien Registration Number/USCIS Number):

Some aliens may write "N/A" in the expiration date field.

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:

2. Form I-94 Admission Number:

3. Foreign Passport Number:

Country of Issuance:

OR

OR

QR Code - Section 1 Do Not Write In This Space

Signature of Employee Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)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.Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State ZIP Code

Employer Completes Next Page

Page 8 of 9Form I-9 03/08/13 N

Employee Last Name, First Name and Middle Initial from Section 1:

Section 2. Employer or Authorized Representative Review and Verification(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR examine a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title, issuing authority, document number, and expiration date, if any.)

CertificationI 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.

The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions.)

Date (mm/dd/yyyy)Signature of Employer or Authorized Representative Title of Employer or Authorized Representative

Employer's Business or Organization Address (Street Number and Name)

Last Name (Family Name) Employer's Business or Organization NameFirst Name (Given Name)

City or Town Zip CodeState

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)A. New Name (if applicable)

C. If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee presented that establishes current employment authorization in the space provided below.

B. Date of Rehire (if applicable) (mm/dd/yyyy):

Document Title: Document Number: Expiration Date (if any)(mm/dd/yyyy):

Signature of Employer or Authorized Representative: Date (mm/dd/yyyy):

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Middle InitialFirst Name (Given Name)Last Name (Family Name)

Issuing Authority: Issuing Authority:

Document Number:

Document Title:Document Title:

Document Number:

Issuing Authority:

List A OR ANDList B List C

Document Number:

Document Title:

Expiration Date (if any)(mm/dd/yyyy):

Document Title:

Issuing Authority:

Expiration Date (if any)(mm/dd/yyyy):

Document Title:

Issuing Authority:

Expiration Date (if any)(mm/dd/yyyy):

Expiration Date (if any)(mm/dd/yyyy): Expiration Date (if any)(mm/dd/yyyy):

Identity and Employment Authorization Identity Employment Authorization

Document Number:

Document Number:

Print Name of Employer or Authorized Representative:

3-D Barcode Do Not Write in This Space

Form W-4 (2017)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. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2017 expires February 15, 2018. See Pub. 505, Tax Withholding and Estimated Tax.Note: If another person can claim you as a dependent on his or her tax return, you can’t claim exemption from withholding if your total income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends).

Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee:• Is age 65 or older,

• Is blind, or

• Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return.

The exceptions don’t apply to supplemental wages greater than $1,000,000.Basic instructions. If you aren’t exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information.Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.

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 Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P.Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details.Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for 2017. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married).Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at www.irs.gov/w4.

Personal Allowances Worksheet (Keep for your records.)A Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A

B Enter “1” if: { • You’re single and have only one job; or• You’re married, have only one job, and your spouse doesn’t work; or . . .• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.

} B

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . DE Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . EF Enter “1” if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . . F

(Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

• If your total income will be less than $70,000 ($100,000 if married), enter “2” for each eligible child; then less “1” if you have two to four eligible children or less “2” if you have five or more eligible children. • If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter “1” for each eligible child. G

H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) ▶ H

For accuracy, complete all worksheets that apply. {

• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2. • If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

Form W-4Department of the Treasury Internal Revenue Service

Employee’s Withholding Allowance Certificate▶ Whether you are entitled to claim a certain number of allowances or exemption from withholding is

subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

OMB No. 1545-0074

20171 Your first name and middle initial Last name

Home address (number and street or rural route)

City or town, state, and ZIP code

2 Your social security number

3 Single Married Married, but withhold at higher Single rate.

Note: If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

4 If your last name differs from that shown on your social security card,

check here. You must call 1-800-772-1213 for a replacement card. ▶

5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 56 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $

7 I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption.• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . ▶ 7

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

Employee’s signature (This form is not valid unless you sign it.) ▶ Date ▶

8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2017)

777 E. Altamonte Dr., Altamonte Springs, FL 32701 Phone: 321-397-2555 Fax: 407-788-3384

WELCOME TO AUE STAFFING, INC

WHAT IS EXPECTED FROM YOU AS AN AUE STAFFING SOLUTIONS EMPLOYEE

1. Keep in daily contact by calling us when available for assignments. If you fail to call immediately at the end of each assignment, you will be considered a voluntary quit and resignation.

2. There is no obligation to accept a proposed assignment; however, if you accept a job assignment, you are expected to finish it. Greet each new assignment with a friendly attitude. It is most important that you arrive on time.

3. Do not make or accept personal telephone calls while at work unless it is an emergency. UNDER NO CIRCUMSTANCES ARE YOU TO MAKE LONG DISTANCE CALLS AT THE COMPANIES TO WHICH YOU ARE ASSIGNED. Do not take cell phones to job site locations.

4. Always arrive on time; contact AUE Staffing, Inc. immediately if you cannot report to work or are arriving late. Always leave a message on our 24 our answering service if you do not personally speak with a Staffing Coordinator.

5. IF YOU ARE HURT OR INJURED ON THE JOB, IMMEDIATELY NOTIFY YOUR LOCAL AUE STAFFING OFFICE AT 321-397-2555.

6. Prior to working over forty (40) hours per week, you must get authorization from the AUE Staffing, Inc. office, only if this involves different clients.

7. You are to dress accordingly. Check with AUE Staffing, Inc. if you have any questions. 8. Please notify us is you have a change of name, address or wish to make a change on our

W-4 form. 9. In order to be contacted for job assignments, it is your responsibility to update any

changes of phone numbers with AUE Staffing, Inc. 10. All job cancellations must be made at least 2 (two) hours before shift begins by calling

the local AUE Staffing, Inc. office at 321-397-2555. 11. All check stubs must be kept as a record of your earnings for future financial inquiries

that you may have from various agencies. 12. Misconduct includes: Failure to follow any of our company procedures, insubordination

to supervisors or to office personnel, sleeping on the job, horse playing on the job, excessive tardiness and absenteeism, unauthorized use of internet activity and the use of profanity and/or abusive language on any assignment or to any AUE Staffing, Inc. personnel will be grounds for immediate termination.

13. It is important that you remember that you are an employee with AUE Staffing, Inc. regardless of the company that you are assigned to. Therefore, if a company to which you are assigned expresses a desire to hire you on a permanent basis, you are to contact your local AUE Staffing, Inc. office. A designated number of hours must be worked by you, our employee. You are not eligible to apply directly with our client unless two (2)

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User
Rafael A. Ramos
User
7-29-15

777 E. Altamonte Dr., Altamonte Springs, FL 32701 Phone: 321-397-2555 Fax: 407-788-3384

months have expired from the day of your last pay check. However, if you accept employment from a client, this is considered a voluntary quit from AUE Staffing, Inc.

14. If you are a no call/no show, walk off, or do not complete an assignment, we will consider this a QUIT and you will be paid the minimum wage for all hours worked for that entire week – no exceptions will be made.

15. AUE Staffing, Inc. is a temporary employment agency that offers seasonal employment, this means that the job will continue for the duration of the season and at no given time constitutes any enforceable contractual rights relating to continuing employment or receipt of benefits between AUE Staffing, Inc. and its employees. Employment at AUE Staffing, Inc., does not mean you are guaranteed a job for a specific period of time, or that you will be called back on the next season. Likewise, you do not commit yourself to AUE Staffing, Inc., for any specific length of time. You and AUE Staffing, Inc., reserve the right to discontinue employment with the Company at any time, for any reason, and without notice or cause.

16. AUE may, at its discretion, perform periodic random drug testing of employees. Certain positions may require mandatory pre-employment and post-employment drug testing. Employees must submit to a drug test within 24 hours of any work-related accident. Failure to do so may result in denial or Workers’ Compensation Benefits.

If you refuse to work, are a no call/no show for a scheduled assignment, do not complete an assignment, or walk off a job, it could affect your unemployment benefits. Upon completion of each assignment, you must contact a representative of AUE Staffing, Inc. for further work assignments. Unemployment benefits may be denied for failure to contact us. Employee Signature: ____________________________ Date: ______________________

777 E. Altamonte Dr., Altamonte Springs, FL 32701 Phone: 321-397-2555 Fax: 407-788-3384

WELCOME TO AUE STAFFING, INC

WHAT IS EXPECTED FROM YOU AS AN AUE STAFFING SOLUTIONS EMPLOYEE

1. Keep in daily contact by calling us when available for assignments. If you fail to call immediately at the end of each assignment, you will be considered a voluntary quit and resignation.

2. There is no obligation to accept a proposed assignment; however, if you accept a job assignment, you are expected to finish it. Greet each new assignment with a friendly attitude. It is most important that you arrive on time.

3. Do not make or accept personal telephone calls while at work unless it is an emergency. UNDER NO CIRCUMSTANCES ARE YOU TO MAKE LONG DISTANCE CALLS AT THE COMPANIES TO WHICH YOU ARE ASSIGNED. Do not take cell phones to job site locations.

4. Always arrive on time; contact AUE Staffing, Inc. immediately if you cannot report to work or are arriving late. Always leave a message on our 24 our answering service if you do not personally speak with a Staffing Coordinator.

5. IF YOU ARE HURT OR INJURED ON THE JOB, IMMEDIATELY NOTIFY YOUR LOCAL AUE STAFFING OFFICE AT 321-397-2555.

6. Prior to working over forty (40) hours per week, you must get authorization from the AUE Staffing, Inc. office, only if this involves different clients.

7. You are to dress accordingly. Check with AUE Staffing, Inc. if you have any questions. 8. Please notify us is you have a change of name, address or wish to make a change on our

W-4 form. 9. In order to be contacted for job assignments, it is your responsibility to update any

changes of phone numbers with AUE Staffing, Inc. 10. All job cancellations must be made at least 2 (two) hours before shift begins by calling

the local AUE Staffing, Inc. office at 321-397-2555. 11. All check stubs must be kept as a record of your earnings for future financial inquiries

that you may have from various agencies. 12. Misconduct includes: Failure to follow any of our company procedures, insubordination

to supervisors or to office personnel, sleeping on the job, horse playing on the job, excessive tardiness and absenteeism, unauthorized use of internet activity and the use of profanity and/or abusive language on any assignment or to any AUE Staffing, Inc. personnel will be grounds for immediate termination.

13. It is important that you remember that you are an employee with AUE Staffing, Inc. regardless of the company that you are assigned to. Therefore, if a company to which you are assigned expresses a desire to hire you on a permanent basis, you are to contact your local AUE Staffing, Inc. office. A designated number of hours must be worked by you, our employee. You are not eligible to apply directly with our client unless two (2)

777 E. Altamonte Dr., Altamonte Springs, FL 32701 Phone: 321-397-2555 Fax: 407-788-3384

months have expired from the day of your last pay check. However, if you accept employment from a client, this is considered a voluntary quit from AUE Staffing, Inc.

14. If you are a no call/no show, walk off, or do not complete an assignment, we will consider this a QUIT and you will be paid the minimum wage for all hours worked for that entire week – no exceptions will be made.

15. AUE Staffing, Inc. is a temporary employment agency that offers seasonal employment, this means that the job will continue for the duration of the season and at no given time constitutes any enforceable contractual rights relating to continuing employment or receipt of benefits between AUE Staffing, Inc. and its employees. Employment at AUE Staffing, Inc., does not mean you are guaranteed a job for a specific period of time, or that you will be called back on the next season. Likewise, you do not commit yourself to AUE Staffing, Inc., for any specific length of time. You and AUE Staffing, Inc., reserve the right to discontinue employment with the Company at any time, for any reason, and without notice or cause.

16. AUE may, at its discretion, perform periodic random drug testing of employees. Certain positions may require mandatory pre-employment and post-employment drug testing. Employees must submit to a drug test within 24 hours of any work-related accident. Failure to do so may result in denial or Workers’ Compensation Benefits.

If you refuse to work, are a no call/no show for a scheduled assignment, do not complete an assignment, or walk off a job, it could affect your unemployment benefits. Upon completion of each assignment, you must contact a representative of AUE Staffing, Inc. for further work assignments. Unemployment benefits may be denied for failure to contact us. Employee Signature: ____________________________ Date: ______________________


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