New Employee Set-Up/Maintenance Form Hire Date Social Security # First Name MI Last Name Street Address City State Zip Code Date of Birth Email Address Phone Number Tax Withholding: Federal Filing Status Married Single # of Allowances State Filing Status Married Single # of Allowances Attachments ** NOTE: Employees that want direct deposit must include a direct deposit form from the bank.ApplicationOUR CORE VALUES ARE: Central Focus: Make the difference. Purpose: Enrich the quality of life of others. SaniClean objectives and values: Consistent performance through reliable cleaning systems. Always be responsible and do the right thing. Be respectful, and think of others first. Protect our reputation through humility, honesty, and integrity. Be willing to adapt and adjust. Contact supervisor for general questions regarding workload or equipment needed for cleaning, communication of schedule change, illness, or any other work-related issue. Welcome to our company A-1 Building Maintenance - SaniClean. It is a pleasure to know that you are going to work with us. Payroll is on the 5th and 20th of each month. Direct Deposit is faster, the check takes longer to receive and can be lost in the mail. Bank Name Account Number Confirm Account Number Routing Number Your Check Will Be? Direct Deposit Check in the Mail Please include a voided check for direct deposit option Equipment Deposit Agreement By signing this form, I, the Production Specialist, acknowledge that the equipment delivered to me is in working condition and that I agree to the following terms: The equipment will be used solely for SaniClean purposes: If equipment is damaged (excluding normal wear and tear), lost or stolen outside of SaniClean or outside of SaniClean hours, I am responsible for any repair or replacement costs; and Upon separation from SaniClean, I will return the equipment after separation from the company or if it is damaged (excluding normal wear and tear), I authorize a payroll deduction to cover any replacement costs that SaniClean may incur. There is a $300 equipment deposit fee that will be deducted $25 per check until paid in full. CHECK BOX OF ACKNOWLEDGMENT Production Specialist Responsibilities Terms: Report all injuries at work urgently. Report all equipment damage to your immediate supervisor. Don’t take chances: use your safety equipment as directed. Follow instructions: Ask your supervisor questions when you have questions. Observe and comply with all safety signs and regulations. Report all unsafe conditions or situations that are potentially dangerous. Only operate equipment and supplies that you are qualified to operate and provided by SaniClean. If in doubt, ask. Speak to your immediate supervisor at any reasonable time about problems or issues affecting your safety or working conditions. The most important part is the individual production specialist, YOU! Without your cooperation, the most stringent terms may be ineffective. Protect yourself and your co-workers by following the rules. Remember: Work safely so you can return home to your family and friends. After all, they need you more. DON’T RISK IT, SAFETY FIRST! CHECK BOX OF ACKNOWLEDGMENT Employee Medical Provider Network Information To provide medical care of the fastest and most appropriate quality in the event of an injury caused at work, we have established a Network of Medical Providers for Workers' Compensation purposes. The following procedures must be followed for all injuries and illnesses caused on the job. Report any on-the-job injuries to your supervisor immediately. For a referral to a medical specialist, contact your employer or claims adjuster. Make sure that all medical treatment is handled solely by the MPN (Medical Provider Network), unless otherwise authorized Direct any questions about the level of care to the PCP (Primary Care Physician), who is the point of reference for all medical treatment. A directory of healthcare providers is available upon request through SaniClean. Please sign below to indicate that you have read and understand the procedures followed in the event of an injury and your responsibilities under our Medical Provider Network. FAMILY AT WORK POLICY Our insurance and workers' compensation policy states that if you bring someone who is not employed by SaniClean they will NOT be covered if they have an accident. If any supervisor finds children or family members in the work area who are NOT on the payroll, you will be fired immediately.This is a ZERO TOLERANCE policy. It has been explained to me that I should NOT bring family members, minors or friends to work who are not on the payroll. CHECK BOX OF ACKNOWLEDGMENT BREAKS & MEALS POLICY In accordance with federal, state, and SaniClean rules, SaniClean provides meal periods and rest periods for employees as follows: A paid break rest period of 10 minutes for every 4 hours worked. A 30-minute UNPAID meal period for every 5 hours worked, which must occur outside of the respective work area. A second 30-minute UNPAID meal period if the employee works more than 10 hours on a business day. This must also occur outside the respective work area. If an employee is NOT scheduled to work more than 6 hrs for the business day however, the employee may voluntarily choose to waive their meal period. If the employee does not work more than 12 hours on a business day, and has already taken his or her first meal period, then he or she may voluntarily choose to waive his or her right to the second meal period. Your signature below affirms that you have received and reviewed a copy of the SaniClean meal or rest period policy and agree to responsibly comply with it. CHECK BOX OF ACKNOWLEDGMENT CalSavers Your employer is facilitating CalSavers, a retirement savings program established by the State of California to make it easier for employees to save for retirement. With CalSavers, enrollment is automatic: you will be enrolled unless you opt out within 30 days of receiving this information. You can opt out or back in at any time. If you do not take action within 30 days of receiving your invitation—choose to opt out or set up your account—you will be automatically enrolled in the program and will start saving part of each paycheck into your own Roth Individual Retirement Account (IRA). CalSavers Employee Information Packet CHECK BOX OF ACKNOWLEDGMENT Additional Forms Please complete the following forms and attach below: W-4 Employee’s Withholding Certificate I-9 Employment Eligibility Verification Submit