Employment Application

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Education - Step 1 of 16

Position applied for

Puesto solicitado

Name *

Nombre

Last name *

Apellido

DOB *

Fecha de nacimiento

Social Secutiry # *

Address *

Street Address / Dirección

Apartment/Unit #

Apartment / Unit

City *

Ciudad

State *

Estado

Zip Code *

Código Postal

Cell Phone *

Teléfono celular

Email *

Correo Electrónico

2) Are you Authorized to work in the U.S? *

Está usted autorizado para trabajar en los Estados Unidos? (Tiene permiso de trabajo?)

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Education

Add Schools

School 1

SCHOOL-CITY-STATE *

Escuela-Ciudad-Estado

MAJOR *

Especializacion

DEGREE *

Grado

NO. OF YEARS

Numero de anos

GRADUATED YES/NO *

Graduado? SI/NO

2nd. School

SCHOOL-CITY-STATE *

Escuela-Ciudad-Estado

MAJOR

Especializacion

DEGREE *

Grado

NO. OF YEARS

Numero de anos

GRADUATED YES/NO

Graduado? SI/NO

3rd. School

NAME OF SCHOOL-CITY-STATE *

Escuela-Ciudad-Estado

MAJOR

Especializacion

DEGREE

Grado

NO. OF YEARS

Numero de anos

GRADUATED YES/NO

Graduado? SI/NO

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FORMERS EMPLOYERS (List Below Last four employers, starting with last first)

Add Previous Employers

Last Employer

Name and Address of Employer *

Nombre y direccion del empleador

From

Desde cuando

Hasta cuando

Last Salary Received

Ultimo salario recibido

Last Position Worked

Ultimo cargo que tenias

Reason for Leaving

Razon de abandono del cargo

The Employer before the last one

El Penultimo Empleador (Previo al ultimo)

Name and Address of Employer *

Nombre y direccion del empleador

From

Desde cuando

Hasta cuando

Last Salary Received

Ultimo salario recibido

Last Position Worked

Ultimo cargo que tenias

Reason for Leaving

Razon de abandono del cargo

Employer #3 (Next in line)

Empleador #3 (Sigue el orden)

Name and Address of Employer *

Nombre y direccion del empleador

From

Desde cuando

Hasta cuando

Last Salary Received

Ultimo salario recibido

Last Position Worked

Ultimo cargo que tenias

Reason for Leaving

Razon de abandono del cargo

Employer #4 (Next in line)

Empleador #4 (Sigue el orden)

Name and Address of Employer *

Nombre y direccion del empleador

From

Desde cuando

Hasta cuando

Last Salary Received

Ultimo salario recibido

Last Position Worked

Ultimo cargo que tenias

Reason for Leaving

Razon de abandono del cargo

DO YOU HAVE TRANSPORTATION? *

Tienes Transporte?

What method of transportation do you use? *

CAR
BUS/TRAIN
OTHER

Cual metodo de transporte usas?

Please, use the space below to list any aditional trade skills, certifications, tools, ETC. wich might be useful in determining job

Por favor, utiliza el espacio a continuación para enumerar cualquier habilidad adicional en oficios, certificaciones, herramientas, etc., que podrían ser útiles para determinar el empleo.

Have you ever worked for a temporary employment service before? *

¿Has trabajado alguna vez para una agencia de empleo temporal antes?

Wich Service(s)?

¿Qué servicio(s)?

Name of business where you were assigned to work?

¿Nombre de la empresa donde te asignaron a trabajar?

Inspired Hope Inc is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, national origin, age, sex, citizenship, physical or mental disability, disabled veteran status, Vietnam-era veterans status, or any other legally protected status.

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GENERAL SAFETY RULES

Please Read Carefully

The company has developed these safety rules patterned after OSHArequirements, Please read and become familiar
with these rules and other safety rules that apply to your job.

1. Report any injury to your employer/supervisor IMMEDIATELY.

2. Report any unsafe condition to your employer/supervisor.

3. Physical misconduct is prohibited at all times.

4. Drinking alcoholic beverages is prohibited on the job. Any employee discovered to be under the influence of
drugs or alcohol will not be permitted to work.

5. If you do not have current First Aid Training, do not move or treat an injured person unless there is an
immediate danger, such as extreme bleeding or stopped breathing.

6. Appropriate clothing and footwear must be worn on the job at all times.

7. Where there is a hazard offalling objects, an approved hard hat must be worn.

8. You should not perform any task unless you are trained to do so and are aware of the hazards associated with
the task.

9. You may be assigned certain personal protective safety equipment. This equipment should be available for use
on the job, be maintained in good condition, and worn when required.

10. Learn safe work practices. When in doubt about performing a task safely, contact your supervisor for instruction
and training.

11. Riding on a hoist-hook or other equipment not designated for such purpose is prohibited always.

12. Never remove or bypass safety devices.

13. Do not approach operating machinery from the blind side; make sure the operator sees you.

14. Be aware of the location of fire extinguishers and first aid kits.

15. Maintain a clean work area at all times.

16. Obey all traffic regulations when operating public vehicles on public highways.

17. When operating or riding in a company vehicle or using your personal vehicle for business purposes, the
vehicle's seat belt must be worn.

18. Be alert to hazards that could affect you and your fellow employess.

19. Obey safety signs and tags.

20. Always perform your assigned task in a safe and proper manner; do not take shortcuts. The taking of shortcuts
and ignoring established safety rules is a leading cause of employee injury.

21. Never bring a weapon to work under any circumstances. This includes guns, knives, explosives, etc.

I certify I have read and understand and will abide by the above listed rules. Failure to do so may be grounds for termination and may disqualify my insurance benefits.

Signature *

Clear Signature

Firma

Date *

Fecha

Print Name *

Escribe tu nombre

Emergency Contact

Contacto de emergencia

Name

Nombre

Relationship

Relacion

Phone number

Numero de telefono

Correo Electronico

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Drug and alcohol screen consent form

Formulário de consentiento para pruebas de Alcohol y Drogas

I *

hereby understand that, as a condition of my employment, I may be subject to drug and/or alcohol testing for any of the following reasons:

➢ Pre-Employment
➢ Post-Hire
➢ Post-Accident
➢ For Cause or Suspicion
➢ Random
➢ Promotion and/or Job Transition

Employee Initials *

Clear Signature

Iniciales del empleado.

I understand that when I am requested to produce a specimen for drug and/or alcohol testing, I must comply immediately. I also understand that a positive drug or alcohol test or that my refusal to produce a specimen
upon request can be cause for termination. I further understand that the use, sale, possession, or distribution of illegal drugs or alcohol, as well as any illegally obtained prescription medication, is a violation of company policy and is cause for immediate termination.

I give my permission for the release of the test results to the company, its agents, representatives and clients for their use in investigating my compliance with the company policy for a drug-and-alcohol-free-work
environment.

I completely understand and accept the terms of this agreement as a condition of my employment.

RELEASE OF CLAIMS AGAINST Inspired Hope Inc:

I am either a temporary worker or am applying for temporary work assignments with Inspired Hope Inc.

I understand that the company provides temporary workers for its customers to work at the customers' project site. In acceptingany work assignment, I acknowledge that I am a temporary employee of the Company ana am not an employee of the Company’s client.

If I am ever injured in the course of my work for the company, I agree that I will look only to the company's
Workers Compensation coverage and not to the Company's Client for any recovery. For Myself, and on behalf of my heirs, executor, personal representative and assigns, I waive, release and forever discharge any claim that I may now have or that may later accrue against any customer of the Company which directly or indirectly arises out of any injuries which may occur to me while on a temporary work assignment or the Company.

In signing this release, I understand that I am not waiving or release any claims which I may have against the
Worker’s Compensation coverage provided by the company.

I have read and I accept *

Sign

He leido y acepto firmar.

Date *

Fecha

DO NOT WRITE BELOW THIS LINE - COMPANY REPRESENTATIVE ONLY

Are you a representative of Inspired Hope? (IHR)

Eres un representante autorizado de Inspired Hope INC?

Password? (IHR) *

FODTF

Drug Test

Passed Drug Test
Faile Drug Test

If Failed, Positive for: *

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EXPERIENCE

Experiencia

Skills: (Check all thth apply)

Accounting
Accounting Clerk
Accounts Payable
Accounts Receivable
Call Center
Call Center (Inbound/Outbound)
Collections
Customer Service Manager
Customer Service Rep
Data Entry
Data Entry (Alpha)
Data Entru (Numeric)
Data Entry (10-Key)
File Clerk
Inside Sales
Insurance Processing
Insurance Bill/Coding
Inventory
Medical Office (Front/Back)
MS Access
MS Excel
MS Office
MS PowerPoint
MS Word
Operator
Operator (switchboard)
Peachtree Accounting
Qualify Assurance
Quality Control
QuickBooks
Receptionist
Sales Rep
Sales Manager
Typing
Internet

Certifications and more...

Check any certifications you currently have:

CDL
Serve Safe
Forklift
Welding
OSHA
Other

Marca todas las certificaciones que tienes actualmente:

Other:

Do you have reliable transportation to get to and from work? *

¿Tienes transporte confiable para ir y regresar del trabajo?

Are you interested in learning about additional training that may be available through Inspired Hope? *

¿Estás interesado/a en conocer sobre capacitación adicional que pueda estar disponible a través de Inspired Hope?

I have read and I accept *

Sign

He leido y acepto firmar.

Date *

Fecha

Print Name *

Escriba su nombre (en letra de imprenta)

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STAND ALONE DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Inspired Hope Inc, may obtain information about you from a third party consumer reporting agency fro employment or volunteer purposes. Thus, you may be subject of a “Consumer Report”, and/or an “Investigative Consumer Report” which may include information about your character, general reputation, personal characteristics, and or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These Reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (driving records), verification of your education or employment history, or other background checks.

A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by Clear Investigative Advantage LLC (CIA) 11330 Legacy Drive, Frisco, Texas 75033 (888) 242-2503 [email protected].

Acknowledgement:

I acknowledge receipt of the STAND ALONE DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both sections. I hereby authorize the obtaining of “Consumer Report” and or “Investigative Consumer Report” by Inspired Hope Inc at any time after receipt of this authorization and throughout my employment or volunteer placement, if applicable. To this end I hereby authorize, without resertvation, any law enforcement agency, administrator, state or federal agency institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Clear Investigative Advantage LLC (CIA) 11330 Legacy Drive, Frisco, Texas 75033 (888) 242-2503 [email protected]. I agree that a facsimile (fax), electronic or photographic copy of this Authorization shall be as valid as the original.

I have read and I accept *

Sign

He leido y acepto firmar.

Print Name *

Escriba su nombre (en letra de imprenta)

Date *

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Employee Pay Selection Record

Inspired Hope INC ("Employer") offers two options to receive your pay, Direct Deposit or the Money Network® Service.
Please review these options and make your selection below.

Option 1: DIRECT DEPOSIT: Employer will pay all of my net pay as selected below ("Direct Deposit") into the account (the "Account") at the financial institution with the routing and account numbers and account type (collectively, "Account Information") I have provided separately to the Employer according to Employer's procedure.

I HEREBY ELECT TO HAVE MY PAY DISTRIBUTED AS INDICATED: (REQUIRED: MAKE ONE CHOICE BY CHECKING THE 1 OR 2 BOX AND WRITING YOUR INITIALS ABOVE YOUR SELECTION BELOW)

Options *

DIRECT DEPOSIT
CHECK PAY

I accept *

Sign

Acepto.

I accept *

Sign

Acepto.

I authorize Employer to pay me by Direct Deposit or Check Pay, according to the selection I checked and initialed above. This Employee Pay Selection Record ("PSR") and Account Information (defined above) must be submitted to Employer within three (3) business days (thirty (30) days in Michigan) of receiving notice to do so.

If I fail to make a selection for Direct Deposit or the Money Network Service, or to provide Account Information (if applicable), I agree that I will be paid using the Money Network Service. However, I understand that I can change my pay selection at any time in the future by submitting a new PSR and Account Information (if applicable) according to Employer's procedure (subject to the time it takes Employer to implement the change).

My election will remain in effect unless Employer and/or Program Manager cancels this arrangement. In case of payment of funds to which I am not entitled, I authorize Employer to withdraw such funds from the Account or the Money Network Service.

To help the government fight the funding of terrorism and money laundering activities, Federal law requires financial institutions to verify and record identity information before opening an account, such as the account provided when you enroll in the Money Network Service. To permit this identification so that my pay can be placed in such an account, I authorize Employer to share my name, address, date of birth, Social Security Number, identification documents, and related personal information with Money Network and the issuing bank.

I have read and I accept *

Sign

He leido y acepto firmar.

Printed Name *

Nombre Escrito

Date *

Fecha

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EMPLOYEE DIRECT DEPOSIT AUTHORIZATION AGREEMENT

[ACH CREDITS & DEBITS]

Select one

New Payroll Deposit
Changue Deposit Information
Revoke Authorization

Date *

Fecha

Name *

Nombre

SSN *

Numero de Seguro Social

Worksite Emp:

Empleador del lugar de trabajo

ID #

Numero de ID

"I authorize my employer or a payroll processor on my employer’s behalf to deposit any amounts owed me by initiating credit entries to my account at the financial institution (the 'BANK') indicated below. Further, I authorize BANK to accept and credit entries indicated by Inspired Hope INC to my account. I acknowledge the deposit of any amount is an advance of funds on behalf of my employer and the responsibility of my employer and not that of a payroll processor, if any, and is subject to the successful collection of the funds by the processor from my employer’s account. If my employer does not make available to the processor the funds that were advanced to make the deposit into my account, I authorize the processor to debit my account to recover said advance. I agree to hold the processor harmless from loss and to indemnify it, limited to the amount of the deposit. I also authorize my employer or the processor, if any, to debit my account in the event of a credit which should not have been made for an amount not to exceed the original amount of the erroneous credit.

Account 1

Account Type (select one): *

Checking
Savings

Tipo de cuenta

Bank Name: *

Nombre del Banco

Transit/ABA Routing # *

Numero de Ruta

Account # *

Numero de cuenta

I Wish to deposit (select one) *

Entire Net Pay
Specific amount
A % of the total amount

Amount *

% of Net Pay *

If you wish to have funds deposited into more than one account, please mark 'Yes' and complete the Account 2 section below.

Account 2

Account Type (select one): *

Checking
Savings

Tipo de cuenta

Bank Name 2: *

Nombre del Banco

Transit/ABA Routing # (2) *

Numero de Ruta

Account # (2) *

Numero de cuenta

I Wish to deposit (select one) . *

Entire Net Pay
Specific amount
A % of the total amount

Amount *

% of Net Pay *

ATTACH VOIDED CHECK

The numbers on the bottom of your voided check are used to make the electronic funds transfer directly to your account.

I have read and I accept *

Sign

He leido y acepto firmar.

Date *

Fecha

A COPY OF THIS AGREEMENT MUST BE GIVEN TO THE EMPLOYEE. NOTE: ALL WRITTEN DEBIT AND CREDIT AUTHORIZATIONS MUST PROVIDE THAT THE EMPLOYEE MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION.

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APPLICATION EMPLOYMENT

THIS SECTION MUST BE COMPLETED BY INSPIRED HOPE INC

Esta seccion solo debe ser completada por Inspired Hope INC

Are you a representative of Inspired Hope?

Eres un representante autorizado de Inspired Hope INC?

Password? *

FODTF

Worksite Employer

Pay Rate

Pay Type (copy)

Jobsite Location State & Zip Code:

Pay Frequency

Pay Type

Work Comp Code

Division, If, Any:

Date

I have read and I accept (copy) *

Sign

He leido y acepto firmar.

You can press the Continue button.

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TO BE COMPLETED BY THE APPLICANT:

The information contained in the Application for Employment is vital to your employment with Inspired Hope Inc. All documents must be filled out completely and signed by you BEFORE an offer of employment can be extended. You will be considered for employment without regard to race, color, religion, sex, national origin, or age. Employment will NEVER begin within 24 hours of submitting this completed application to Inspired Hope Inc or your Worksite Employer, regardless of the date this application is completed.

Name *

Nombre

Social Security # *

Numero de Seguro Social

Street Address *

City, State, Zip *

Ciudad, Estado, Codigo Postal

Email *

Correo Electronico

Emergency Contact Name

Nombre de persona para casos de Emergencias

Date of Birth *

Fecha d Nacimiento

Phone Number *

Numero de telefono

Emergency Contact Phone

Numero de persona para casos de Emergencias

ONE OR MORE OF THE FOLLOWING CONDITIONS MET BY AN EMPLOYEE CONSTITUTES A VOLUNTARY QUIT CONNECTED WITH THE WORK AND UNEMPLOYMENT BENEFITS WILL BE DENIED:

1- Failure to call Inspired Hope Inc at the end of the assignment +1 (407) 283-2085 with notification of your availability, regardless of the reason of separation with the client;

2- Failure to call three (3) times weekly when not on assignment. +1 (407) 283-2085

3- Failure to notify Inspired Hope Inc with your change of address or phone number;

4- Refusal or failure to accept a suitable work assignment based upon pay, qualification or location; and

5- Inspired Hope Inc receipt of an unemployment claim from you without prior notification of your availability.

I. ACKNOWLEDGEMENT AND VERIFICATION

By initialing and signing this application for employment, I acknowledge and verify that I have received a copy of Inspired Hope policies, have read, fully understand, and agree if hired to abide by these policies.

I understand this information is not for payroll purposes only, and I have been advised and understand that if I am hired, I will be an employee of Inspired Hope Inc and leased to one of its client companies. The client company will be my work-site employer and will direct the daily activities of my employment

I have read and I accept *

Sign

He leido y acepto firmar.

I have been advised and understand that Inspired Hope Inc carries workers compensation.

I have read and I accept *

Sign

He leido y acepto firmar.

I have received and will comply with 1) The Inspired Hope Inc Accident/Injury/Illness Procedures and the Inspired Hope Inc Accident Procedures, and 2) The Inspired Hope Inc Substance Abuse Policy.

I have read and I accept *

Sign

He leido y acepto firmar.

I understand and agree that either Inspired Hope Inc or I can terminate our employment relationship at any time as I am applying to become an at-will employee of Inspired Hope Inc, AND I have received and will comply with the Inspired Hope Inc Separation Procedures.

I have read and I accept *

Sign

He leido y acepto firmar.

I have been advised and understand that at any time during my employment if I am not paid directly by Inspired Hope Inc for any pay period, I will NOT be considered and employee of Inspired Hope Inc and will NOT be eligible for workers compensation coverage.

I have read and I accept *

Sign

He leido y acepto firmar.

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II. HIPPA Authorization

I authorize Inspired Hope Inc, or its agent, subsidiary, or affiliate to obtain any medical records (excluding psychotherapy notes) from any physicians, hospitals, and/or other healthcare providers concerning my care. I also authorize any physicians, hospitals, and/or other healthcare providers to furnish any medical records (excluding psychotherapy notes) concerning my care to Inspired Hope Inc, or its agent, subsidiary, or affiliate. This information is needed to evaluate my health condition and continued eligibility for employment and insurance coverage. I understand that the entities indicated above can request medical records for up to the past 10 years.
I further authorize Inspired Hope Inc, or its agent, subsidiary, or affiliate to require me to submit to an alcohol or drug test following any on-the-job injury for which I seek medical treatment, and to receive the results. I understand that I may revoke this Authorization at any time by submitting written notice to Inspired Hope Inc.

I understand that the information disclosed by this authorization could be re-disclosed by the person receiving it and is no longer protected by federal or state legal privacy requirements. Inspired Hope Inc, its affiliates, its employees, and officers are not legally responsible or liable for the re-disclosure of the information indicated on this authorization.

Printed Name of Individual *

Nombre del individuo Escrito

Date *

I have read and I accept *

Sign

He leido y acepto firmar.

III. Payroll Deduction Authorization

By signing below, I authorize deductions, when applicable, to be taken out of my paycheck for tools, uniforms, health insurance, errors in payroll, court-ordered deductions, overpayments, and any other work-related deductions allowable by law

Date *

I have read and I accept *

Sign

He leido y acepto firmar.

IV. Wage Disputes

I understand and agree that the client company is solely obligated to pay any wages for which the obligation to pay is created by an agreement, contract, plan, or policy between the client company and myself, and that Inspired Hope Inc has not contracted to pay.

Date *

I have read and I accept *

Sign

He leido y acepto firmar.

V. Arbitration

I agree that my sole recourse for resolving any dispute with Inspired Hope Inc arising under my employment, including but not limited to wage claims, shall be to arbitrate such dispute. Such arbitration shall be pursuant to the arbitration laws of the State of New Jersey and the rules, then obtaining, of the American Arbitration Association. Venue of any action shall be in New Jersey. Inspired Hope Inc is based in Medford, New Jersey, and the applicant acknowledges that this Agreement is to be partially performed in Medford, New Jersey.

Date *

I have read and I accept *

Sign

He leido y acepto firmar.

In signing below, I acknowledge that I have read and understand all the terms of this Application for Employment.

Date *

I have read and I accept *

Sign

He leido y acepto firmar.

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W-9

(Rev. October 2018)
Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

▶Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the requester. Do not send to the IRS.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. *

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. (Skip) *

Individual/sole proprietor or single-member LLC

5 Address (number, street, and apt. or suite no.) See instructions. *

6 City, state, and ZIP code *

7 List account number(s) here (optional)

Requester’s name and address (optional)

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Social Security Number

Write the first 3 digits of your SSN *

Escriba SOLO los primeros 3 digitos de su SSN

Write the next 2 (TWO) digits *

Write the last 4 digits of your SSN. *

Part II Certification

Under penalties of perjury, I certify that:

1.The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2.I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal RevenueService (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I amno longer subject to backup withholding; and

3.I am a U.S. citizen or other U.S. person (defined below); and

4.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Signature of U.S. person

Clear Signature

Firma aqui

General Instructions

General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of Form

An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.
•Form 1099-INT (interest earned or paid)

Date

•Form 1099-DIV (dividends, including those from stocks or mutualfunds)

•Form 1099-MISC (various types of income, prizes, awards, or grossproceeds)

•Form 1099-B (stock or mutual fund sales and certain othertransactions by brokers)

•Form 1099-S (proceeds from real estate transactions)

•Form 1099-K (merchant card and third party network transactions)

•Form 1098 (home mortgage interest), 1098-E (student loan interest),1098-T (tuition)

•Form 1099-C (canceled debt)

•Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a residentalien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

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Inspired Hope Inc

Accident/Injuries/Illness Procedures

(Spanish version available upon request)
The following procedures must be followed for all work-related injuries:

1. ALL ACCIDENTS/INJURIES/ILLNESSES MUST BE REPORTED TO THE FOREMAN OR SUPERVISOR, EVEN IF NO MEDICAL ATTENTION IS REQUIRED. The injured employee must complete the form entitled: Injury/Illness Incident Report. Once completed, the form will be placed in the employee's medical file for future reference. Please email this form to (407) 283-2085

2. The foreman/supervisor must complete a First Report of Injury/Illness form regardless of whether or not medical attention is required for the injured employee. Please email this form to [email protected]

3. Should the injury require medical attention, but it is not an emergency situation, have the foreman/supervisor call the new injury department at (407) 283-2085 prior to seeking a medical facility. In case of an emergency, have the foreman/supervisor call and report which medical facility the employee is being transported to. It is important that Inspired Hope Inc authorizes treatment, arranges proper billing, and determines that the facility follows proper procedures.

4. Should an employee be off work and on disability, he/she must notify his or her foreman/supervisor. Should the employee be off for an extended period of time, the employee must check in with his or her office by visiting or calling in at least once a week to (407) 283-2085 Inspired Hope Inc must be advised of the employee's status. Upon receiving a release to return to work, the employee is required to call his or her jobsite to report his or her availability, as well as notifying Inspired Hope via telephone call.

5. Doctor's restrictions must be followed for all employees on light duty. The employee may return to his/her regular duties only when a release is provided to Inspired Hope Inc in writing by the doctor. It is the employee's responsibility to inform their doctor about the types of light-duty work Inspired Hope Inc provides and request light-duty work from the jobsite.

6. An alcohol and drug screen is required for all injuries, accidents, or injuries. The test is required to be taken immediately and within 24 hours after an injury, accident, or injury is reported or upon the claimant receiving medical attention, whichever is first. Refusal to submit to a drug test will result in affirmation of a positive drug and alcohol test.

7. I understand and agree to abide by the above accident/injuries/illness procedures. I understand that any payments to me or to anyone else for expenses in connection with my accident and resulting injury are not an admission of liability on the part of Inspired Hope Inc. In the event of an injury, I authorize full access to copies of medical records, radiology reports, drug/alcohol screenings, and documents of any kind relating to my past or present injury/illness to Inspired Hope Inc. I hereby agree to release this information and hold all such medical providers harmless from the release of this information as set forth in this authorization statement.

8. Report any unsafe conditions to your supervisor.

9. If, at any time, you are unsure of how to perform a job, you are to stop and check with your supervisor. This is for your safety and the safety of your fellow workers.

10. All employees who operate company vehicles or equipment, or are passengers in company vehicles, must wear their seat belts at all times. On equipment, if there is not a designated seat with a belt for a passenger

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ID Card - Both Sides (2 files) *

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ID en Ambas Caras

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SSN Una cara

TAKE A SELFIE (White background with both shoulders visible.) *

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TÓMATE UNA SELFIE (FONDO CLARO AMBOS HOMBROS VISIBLES)

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Education

School 1

2nd. School

3rd. School

FORMERS EMPLOYERS (List Below Last four employers, starting with last first)

Last Employer

The Employer before the last one

Employer #3 (Next in line)

Employer #4 (Next in line)

Inspired Hope Inc is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, national origin, age, sex, citizenship, physical or mental disability, disabled veteran status, Vietnam-era veterans status, or any other legally protected status.

GENERAL SAFETY RULES

Please Read Carefully

Emergency Contact

Drug and alcohol screen consent form

hereby understand that, as a condition of my employment, I may be subject to drug and/or alcohol testing for any of the following reasons:

DO NOT WRITE BELOW THIS LINE - COMPANY REPRESENTATIVE ONLY

EXPERIENCE

Certifications and more...

STAND ALONE DISCLOSURE REGARDING BACKGROUND INVESTIGATION

A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT

Acknowledgement:

Employee Pay Selection Record

EMPLOYEE DIRECT DEPOSIT AUTHORIZATION AGREEMENT

Account 1

Account 2

ATTACH VOIDED CHECK

APPLICATION EMPLOYMENT

THIS SECTION MUST BE COMPLETED BY INSPIRED HOPE INC

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TO BE COMPLETED BY THE APPLICANT:

ONE OR MORE OF THE FOLLOWING CONDITIONS MET BY AN EMPLOYEE CONSTITUTES A VOLUNTARY QUIT CONNECTED WITH THE WORK AND UNEMPLOYMENT BENEFITS WILL BE DENIED:

I. ACKNOWLEDGEMENT AND VERIFICATION

II. HIPPA Authorization

III. Payroll Deduction Authorization

IV. Wage Disputes

V. Arbitration

In signing below, I acknowledge that I have read and understand all the terms of this Application for Employment.

W-9

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

Part I Taxpayer Identification Number (TIN)

Part II Certification

General Instructions

Purpose of Form

Inspired Hope Inc

Accident/Injuries/Illness Procedures

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