sanvar staffing llc · oxnard, ca 93036 office 805-718-0737 toll free application for employment...

Revised Aug 22, 2018 SANVAR STAFFING LLC

EMPLOYMENT APPLICATION CHECKLIST Employee Name: __________________________________________________________________ (Last) (First) (Middle Initial)

Hired Date: _________________________ Termination Date:_____________________ Branch Location: ________________________ Property: ____________________________ Circle One: E (W-4) or C (W-9) Pay Rate: Salary:$____________Hourly:$_________

Orientation Checklist: Hiring Manger will complete by verifying items below are accurately completed and returned to the HR Department for processing. Branch HR

• Employment Application

• Signed I-9 form (employee)

• 2 Forms of Identification

• Background Consent & Authorization Form

• Employee Contact Information

• W-4 or Withholding Election (Arizona)

• Company Policies & Procedures o Harassment & Sexual Harassment Policy

o Drug Free Workplace Policy

o Weapons Free Workplace Policy

o Medical Records Release Authorization

o Non-Subscriber Information Form (Texas)

o Light Duty, Early Return to Work Policy

o Safety Training Agreement Documents

• Reference Check

• Non-Compete Agreement (office staff & managers only)

• Attachments 1,3,4,& 5 (Guidant staff only)

• Exhibits A & B (Marriott staff only)

Branch Office Manager Signature:_______________________________Date:__________________

HR Department Only

• Drug Test Results

• Background Results

• National Sex Offender Search

• E-Verify

HR Department Signature:___________________________________Date____________________

Revised Aug 22, 2018 /SANVAR STAFFING LLC P.O. Box 540384 Grand Prairie, TX 75054 PHONE 805-718-0737 TOLL FREE

EMPLOYEE CONTACT INFORMATION

Please complete the following information to ensure we maintain a current record of contact information for you and your emergency contacts.

PERSONAL INFORMATION (To be completed by employee)

Employee Name: _____________________________________________________________________ Address: _________________________________________ City/State: _________________________ Home Phone: ________________ Cell Phone: _______________ Email: ________________________

EMERGENCY CONTACT INFORMATION

# 1 Contact: _________________________________________________________________________ First Last Relationship: __________________________ Contact Number: ______________________________ # 2 Contact: _________________________________________________________________________ First Last Relationship: __________________________ Contact Number: ______________________________

Please return the completed form to HR Department

Revised Aug 22, 2018 SANVAR STAFFING LLC 300 E. Esplanade Dr. #934 Oxnard, CA 93036 OFFICE 805-718-0737 TOLL FREE Application for Employment

PLEASE PRINT

SanVar Staffing LLC is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the bases of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status. Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and/or interview process should contact a representative of the Personnel Department. Position(s) applied for ____________________________________________Date of Application_____/_____/______ Name: ______________________________________________________________________________________________________ Last First Middle Address: ____________________________________________________________________________________________________ Street City State Zip Telephone: __________________________ Driver’s license number if job related: ____________________________________ Number State Are you at least 18 years of age? ……………………………………………………………………….………………….….� Yes � No

Have you ever been employed by SanVar Staffing LLC.?.............................................…………………………..� Yes � No

Are you legally eligible for employment in the United States?………………...…………………………………………….� Yes � No (If you are offered employment, you will be required to provide documentation to verify eligibility).

Date available for work…………………………………………………………………………………………… _____/_____/_______

Type of employment desired � Full-Time � Part-Time � Seasonal � Educational Co-op

Are you able to meet the attendance requirements for this position?………………………………………………………� Yes � No Education: Please indicate education or training below. High School: No. of Yrs. Completed (circle one) 1 2 3 4. Diploma: ____Yes ____No GED: ___Yes ___No College: ___Yes ___No Vocational School or Training: __________________________________________________________ _

Employment History List your last (2) employers, assignments or volunteer activities, starting with the most recent including military experience. From:

To:

Employer:

Telephone: ( )

Job Title:

Address:

Immediate Supervisor/Title:

Summarize the Nature of Worked Performed And Job Responsibilities:

Reason for Leaving:

Hourly Rate/Salary Start $ __________ Per________ Final $ _________ Per_______

Revised Aug 22, 2018 From:

To:

Employer:

Telephone: ( )

Job Title:

Address:

Immediate Supervisor/Title:

Summarize the Nature of Worked Performed And Job Responsibilities:

Reason for Leaving:

Hourly Rate/Salary Start $ __________ Per________ Final $ _________ Per_______

List any specific skill you are capable of performing: _______________________________________________________________________________________________________ List any equipment you are capable of operating:

_______________________________________________________________________________________________________

PLEASE READ CAREFULLY AND SIGN BELOW I here certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize SanVar Staffing LLC to verify their accuracy and to obtain reference information on my work performance. I hereby release SanVar Staffing LLC from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand should an employment offer be extended to me and accepted, I will fully adhere to the policies, rules and regulations of employment of the Employer. I understand and agree that my employment is at will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of the company has any authority to enter into any agreement for employment for any specific period or to make any agreement contrary to the foregoing and then only in writing signed by an officer. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigation or credit agencies or bureaus of your choice

The information above is true and accurate to the best of my knowledge. Applicant Signature: ______________________________ Date:_____________________

Revised Aug 22, 2018

SANVAR STAFFING LLC

Background Screening Consent & Authorization Form

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize SanVar Staffing LLC and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records. Understanding, by signing Consent and Authorization Form I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish SanVar Staffing LLC or its designated agents with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original. I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided to me.

Revised Aug 22, 2018 I, ________________________________________________ authorize SanVar Staffing LLC to conduct the following background screen for employment purposes.

Please Print Clearly

1. Full Name: _______________________________ Phone Number: ___________________

2. Maiden Last Name: _________________________________________________________

3. List Any Former Names Used: ________________________________________________

4. Social Security Number: ______-_____-______ Date of Birth: _____/_____/_____

5. Current Address: ___________________________________________________________ City, State & Zip

6. Previous Address within the last 5 years. Address: ___________________________________________________________________

City, State & Zip Address: ___________________________________________________________________

City, State & Zip

7. Driver’s License Number:____________________ State Issued: _____________________ By signing below, you are certifying the above information is true and correct. ___________________________________________ ______________________________ Signature Date


POLICIES AND PROCEDURES

The following are company policies and procedures, please read them carefully, to be sure you understand. If something is not clear please ask for clarifications. After you have read and understand please sign last page and initial each item numbered, turn one copy into your supervisor and keep one for yourself. *Los siguientes procedimientos y políticas de la compania. Favor de preguntar a su supervisor para que le aclare. Después de leerlo y entenderlo por favor firme la última página y poner iniciales en cada número, dele una copia al supervisor y la otra quedesela usted.

1. All employees must present proof of Employment Eligibility prior to starting work. (_____)

* Todo empleado deberá presentar prueba de elegibilidad de empleo en el país, antes de comenzar el trabajo.

2. All employees are to report to work at designated time daily. Absenteeism and tardiness will not be acceptable. There must be at least 1 week notice to request extra time off. A four (4) hour advance notice is required if calling in sick. (_____)

*Todo trabajador deberá estar a tiempo en su horario asignado. Las llegadas tardes o ausencias no serán permitidas sin previo aviso. Para pedir un día de descanso necesitamos 1 semana de aviso.

3. Report to work at least 15 minutes prior to designated start time. Employees will sign

or clock themselves in and out each day. Signing or clocking in for someone else is prohibited. (_____)

* Todo individuo deberá firmar individualmente su entrada y salida.

4. It’s the responsibility of all employees to follow instructions given by supervisors(s) or managers regarding job related duties. (_____)

* Cada empleado tiene la obligación de seguir las instrucciones de sus superiores o managers sobre sus asignamientos de trabajo.

5. Employees are required to follow-up on all request(s) given by property management or tenant. If requests are questionable please consult with your supervisor. (_____)

Revised Aug 22, 2018 * Todo los empleados deben atender y seguir las indicaciones del manejador o inquilinos. Si la orden esta dudosa no es su responsabilidad debe preguntar a su supervisor.

6. Employees will report to work in clean, neat uniform daily. Employees who report to work out of uniform you will be sent home. (_____) * Todos los empleados deben presentar al trabajo con su uniforme limpio, planchado y apariencia presentable, si no lleva uniforme puesto se le regresara a su casa.

7. Absolutely no one other than the employees of SanVar Staffing LLC is allowed on a job site. Children are not allowed any time. (_____)

* No se permiten visitas de amigos o familiares, prohibido llevar a menores de edad.

8. Break and lunches will be taken at times and locations designated by your direct supervisor. There will be no smoking, eating or drinking while working. (_____) * Descansos y hora de lonche deberá ser usado en las áreas designadas por el supervisor o manager. No se permite fumar, comer o beber dentro de las áreas de trabajo.

9. While on assignment time will be spent in productive activities. No visitors or visiting with tenants, only respond to request. (_____) *En el trabajo solamente se realizaran actividades productivas, no se deberá perder el tiempo visitando o perturbando a los demás. 10. Employees of SanVar Staffing LLC agree to submit to a polygraph test, background or drugs screening if required by a facility in which they are working. (_____) * Todos los empleados deberán ser sometidos a prueba de record policial, examen de drogas, si el cliente lo requiere. 11. Employees will familiarize themselves with their assigned areas on how to best fulfill and complete specific duties each day. When an area is completed, make sure items are back in place, turn off lights and lock doors. Failure to do so could lead to corrective action. (_____) * Todos los empleados se familiariazaran con su areas. Deberán revisar su áreas cuando terminen y todo esté en orden. 12. All policies, security regulation and safety regulations of the facility must be observed. (_____) *Toda la política, regulaciones de seguida y cuidados del edificio deberan observar cuidadosamente. 13. Customer equipment and material such as radio, type writers, copy machines, telephone, office supplies, ect. Are not to be used at any time without prior approval from the authorized person. (_____)

Revised Aug 22, 2018 * No se permite usar los materiales y equipo en las oficinas tales como radio, máquina de escribir, fotocopiadoras etc. 14. Absolutely no use of alcohol, drugs at any time while on assignment. Theft will not be tolerated. Any of these actions will result in immediate termination and/ or prosecution. (_____) * No se permitirá el uso de drogas, alcohol, o robo. Estas acciones darán resultado a una terminación inmediata y / o persecución.

__________________________ Employee Name (print) _________________________ _________________ Employee Signature: Date:


Company Uniform Policy All Employees hired by SanVar Staffing LLC are required to buy their uniform and the cost will be deducted from first paychecks. I understand and agree that, as a condition of employment with SanVar Staffing LLC, I am required to buy my uniform which will be deducted in 3 equal installments from first paychecks; if employment is terminated by either party remaining amount will be deducted on final paycheck. Only the first set of uniforms will be available in installments, any others after that will be paid outright in full. Every purchased uniform should be returned in fairly new condition for a full refund, provided by SanVar Staffing LLC.

__________________________________________ ________________________

Employee Name (print) Date

____________________________________________________ Signature


HARASSMENT AND SEXUAL HARASSMENT POLICY

SanVar Staffing LLC is committed to providing a workplace that is free of discrimination, harassment and sexual harassment. Discrimination: SanVar Staffing LLC strictly prohibits discrimination including: discrimination based on the basis of race, color, religions, gender, age, mental or physical disability, medical condition, national origin, marital status, veteran status, sexual orientation, or any other characteristic protected under federal, state or local law. Verbal Harassment: Verbal harassment is strictly prohibited. This includes unwelcome jokes, remarks about a person’s body, slurs, comment about a person’s national origin or unwelcome comments such as “honey, doll, sweetheart and baby.” Visual Harassment: Visual harassment will not be tolerated. This would include offensive or pornographic calendars, cartoons, pictures, magazines, photographs or other written materials. Sexual Harassment: Sexual harassment can include unwelcome advances, inappropriate touching, and unwelcome comments or eye contact. This is called a Hostile Work Environment. Quid Pro Quo: Sexual harassment can also include granting favors, special treatment, or promotions to an employee in exchange for sexual favors. This is called Quid Pro Quo. This is also prohibited. Sexual harassment is often confusing. A good definition is: If you would feel uncomfortable saying or doing something to someone if your spouse or significant other was standing behind you, it is probably sexual harassment. I have read and understand SanVar Staffing LLC Sexual Harassment Policy. I also understand that if I feel I have been discriminated against, harassed, or sexually harassed, I should contact my Supervisor or if uncomfortable call the HR Department immediately! At 805-718-0737 _____________________________ Print Name

__________________________________ _________________________ Employee Signature: Date:


DRUG-FREE WORKPLACE POLICY SanVar Staffing LLC intends to help provide a safe and drug-free work environment for our clients and our employees. With this goal in mind and because of the serious drug abuse problem in today's workplace, we are establishing the following policy for existing and future employees of SanVar Staffing LLC The Company explicitly prohibits:

• The use, possession, solicitation for, or sale of narcotics or other illegal drugs, alcohol, or prescription medication without a prescription on Company or customer premises or while performing an assignment.

• Being impaired or under the influence of legal or illegal drugs or alcohol away from the Company or customer premises, if such impairment or influence adversely affects the employee's work performance, the safety of the employee or of others, or puts at risk the Company's reputation.

• Possession, use, solicitation for, or sale of legal or illegal drugs or alcohol away from the Company or customer premises, if such activity or involvement adversely affects the employee's work performance, the safety of the employee or of others, or puts at risk the Company's reputation.

• The presence of any detectable amount of prohibited substances in the employee's system while at work, while on the premises of the company or its customers, or while on company business. "Prohibited substances" include illegal drugs, alcohol, or prescription drugs not taken in accordance with a prescription given to the employee.

The Company will conduct drug and/or alcohol testing under any of the following circumstances: • RANDOM TESTING: Employees may be selected at random for drug and/or alcohol testing at any

interval determined by the Company. • FOR-CAUSE TESTING: The Company may ask an employee to submit to a drug and/or alcohol test at

any time it feels that the employee may be under the influence of drugs or alcohol, including, but not limited to, the following circumstances: evidence of drugs or alcohol on or about the employee's person or in the employee's vicinity, unusual conduct on the employee's part that suggests impairment or influence of drugs or alcohol, negative performance patterns, or excessive and unexplained absenteeism or tardiness.

• POST-ACCIDENT TESTING: Any employee involved in an on-the-job accident or injury under circumstances that suggest possible use or influence of drugs or alcohol in the accident or injury event may be asked to submit to a drug and/or alcohol test. "Involved in an on-the-job accident or injury" means not only the one who was or could have been injured, but also any employee who potentially contributed to the accident or injury event in any way.

If an employee is tested for drugs or alcohol outside of the employment context and the results indicate a violation of this policy, or if an employee refuses a request to submit to testing under this policy, the employee may be subject to appropriate disciplinary action, up to and possibly including discharge from employment. In such a case, the employee will be given an opportunity to explain the circumstances prior to any final employment action becoming effective. ______________________________________ _________________________ Employee Signature: Date:


WEAPONS-FREE WORKPLACE POLICY

SanVar Staffing LLC is a Weapons Free Company.

Employees may not, at any time while on any property or premises owned, leased, controlled or contacted by SanVar Staffing LLC, including all locations where company business is conducted, such as customer locations, client locations, trade shows, restaurants, company event venues, and so forth, possess or use any weapon.

Weapons include, but are not limited to, guns, knives or swords with blades over four inches in length, explosives, and any chemical whose purpose is to cause harm to another person.

Regardless of whether an employee possesses a concealed weapons permit (CCW) or is allowed by law to possess a weapon, weapons are prohibited on any company property or premises. They are also banned in any location in which the employee represents SanVar Staffing LLC. for business purposes, including those listed above.

Employees who violate this policy will be subject to disciplinary actions, up to employment termination. Termination of employment would be characterized as termination for case.

________________________ ______________ Employee Signature: Date:


MEDICAL RECORDS RELEASE AUTHORIZATION

HIPAA PRIVACY AND SECURITY

Healthcare providers, employees, consultants, business associates and others who have a business reason to create, maintain, view, or transmit confidential data relative to the Employees medical care have a legal and ethical duty to maintain the privacy, security and confidentiality of such medical information.

HIPAA and the Privacy of Medical Records

To share your confidential medical information employees of SanVar Staffing LLC are required to sign a medical records release form. Health care providers and insurers are required by law to keep your medical records and health information strictly confidential, with an emphasis on making sure personally identifiable data is protected. The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, codified these requirements. The release form is essentially a waiver from liability under HIPAA.

In the event of a work-related injury, I ________________________________hereby authorize the release of my medical records to SanVar Staffing LLC to appropriately assist in my medical treatment and compare my medical history to a work-related injury. ______________________________________ _________________________ Employee Signature: Date:

Revised Aug 22, 2018