TPS Family of Companies (Coast Personnel Services, The Staffing Solutions Group (SSG), United Staffing Services (USS), Personnel Plus, MAC Inc., Manutec and Decton LI, are equal opportunity employers and all employment decisions are made without regard to race, color, creed, sex, sexual, orientation, religion, gender, gender identity, national origin, age, disability, ancestry, medical condition, marital status, veteran status, citizenship, status, sexual orientation, or any other category or status protected by federal, state or local laws of an individual or that individual’s associates or relatives.

Instructions:
Please answer ALL questions, where applicable, completely and truthfully to the best of your knowledge and belief. Type or print in ink as carefully as possible. Name in Section 1 must be as it appears on your social security card or other official documents.

SECTION 1: PERSONAL INFORMATION

SECTION 2: GENERAL INFORMATION

SECTION 3: EDUCATIONAL BACKGROUND

BEGINNING WITH HIGH SCHOOL, PLEASE LIST THE INSTITUTIONS WHERE YOU HAVE OBTAINED A DEGREE, DIPLOMA, OR EQUIVALENT.
HIGH SCHOOL
COLLEGE
HIGH SCHOOL
COLLEGE
HIGH SCHOOL
COLLEGE
HIGH SCHOOL
COLLEGE
HIGH SCHOOL
COLLEGE

SECTION 4: EMPLOYMENT HISTORY

SECTION 5: EMPLOYMENT REFERENCES

PLEASE PROVIDE AT LEAST TWO REFERENCES (NOT RELATED TO YOU), WHO ARE ABLE TO PROVIDE INFORMATION ON YOUR EMPLOYMENT EXPERIENCE.

SECTION 6: ACKNOWLEDGMENT AND UNDERSTANDING

This Employment Application does not inquire about criminal convictions in an effort to consider all qualified candidates for employment. I understand that if I continue to be considered for employment, I may be required to disclose criminal history information and consent to a background check as a condition of employment. I give permission for my background results to be released to the Company and/or the organization at which I may be placed to work. No applicant shall be denied employment solely on the grounds of conviction of a criminal offense. A criminal conviction may be relevant if job-related, but does not necessarily bar applicants from employment. The Company will consider factors such as the nature of the offense, the time elapsed, and the nature of the job. In addition, I release the Company, my former employers and all other persons and entities from any and all claims, demands or liabilities related in any way to my background investigation or disclosure.This Employment Application does not inquire about criminal convictions in an effort to consider all qualified candidates for employment. I understand that if I continue to be considered for employment, I may be required to disclose criminal history information and consent to a background check as a condition of employment. I give permission for my background results to be released to the Company and/or the organization at which I may be placed to work. No applicant shall be denied employment solely on the grounds of conviction of a criminal offense. A criminal conviction may be relevant if job-related, but does not necessarily bar applicants from employment. The Company will consider factors such as the nature of the offense, the time elapsed, and the nature of the job. In addition, I release the Company, my former employers and all other persons and entities from any and all claims, demands or liabilities related in any way to my background investigation or disclosure.

I understand that I may be required to submit to testing for detection of drugs and alcohol. I give permission for test results to be released to the Company and/or the organization at which I may be placed to work. I understand that the Company is a Drug Free workplace and that positive test results, refusal to be tested or any attempt to affect the test results or test sample may result in withdrawal of my application for employment, withdrawal of any provisional employment offer I have received or termination of employment, depending on when results are received.

I certify that I have not falsified or knowingly withheld any information that might adversely affect my chances for employment, and that the answers given by me are true and correct to the best of my knowledge. I have personally completed this application, and I understand that any omission or misstatement of material fact on this application or any false or misleading information or document shall be grounds for rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.

I understand that nothing contained in my application or conveyed during any interview(s) which may or may not be granted, or during my employment, if hired, is intended to create an employment contract between myself and the Company. I understand my potential employment will be at-will, and may be terminated by either of us at any time, with or without cause and with or without notice. I understand and agree that the submission of this application does not imply or guarantee that I will be placed for employment or employed for any period of time.

I understand that if I am provided a temporary assignment by the Company, and that assignment ends, I may be eligible to be placed at other temporary assignments. I further understand that it is my responsibility to provide my availability to work on a weekly basis, and if I do not, I will be considered unavailable for work.

TPS Family of Companies (Coast Personnel Services, The Staffing Solutions Group (SSG), United Staffing Services (USS), Personnel Plus, MAC Inc., Manutec and Decton LI and the undersigned applicant hereby agree to the terms and provisions of the TPS Family of Companies, Mutual Agreement to Arbitrate Policy to the extent permitted by federal and state law. The full agreement is available upon request prior to an offer of employment and is provided upon offer of employment with the Company.

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Release Of Medical Information

I,

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authorize TPS Solutions Inc., dba. The Staffing Solutions Group to request and obtain all records regarding any industrial and/or occupational disease involving myself and TPS/The Staffing Solutions Group. This is to include, but it is not limited to, doctor’s reports, nurse’s notes, follow up reports, medical bills, and test results. A fax or photocopy of this authorization shall be considered as effective and valid as the original. The release shall be in effect until specifically rescinded by me in writing.

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Employee Acknowledgement of What To Do In The Event of a Work Injury

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acknowledge and understand that I must report any Worker’s Compensation injury immediately to my workplace supervisor and The Staffing Solutions Group representative within 24 hours. In an emergency, I understand that I should seek immediate medical treatment as soon as possible. I must then contact The Staffing Solutions Group representative for further medical treatment and claim direction. If I am injured on the job, I will notify my supervisor immediately, who will then contact The Staffing Solutions Group for claim reporting and continued medical treatment, including the selection of a treating physician. I acknowledge that the applicable Worker’s Compensation Insurance Notice(s) is/are posted for my use in case of a Worker’s Compensation Injury.

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Authorization and Consent for Drug and Alcohol Screen

I give full permission and authorization to have the TPS Solutions Inc., dba The Staffing Solutions Group., authorized representative, or medical physician send a specimen of my urine and/or blood to a laboratory for screening using N.I.D.A standard for the presence of illegal drugs, alcohol, or prescription medication is taken without a prescription.

I will hold parties involved harmless, meaning I will not send or hold them responsible for any alleged harm to me or interfering with my obtaining a job or continuing employment as a result of not submitting to the tests or as a result of the determination of the testing, This includes, but is not limited to, any possible clerical or laboratory errors made.

I understand that this is a legally binding document, which is binding because of TPS Solutions Inc., dba The Staffing Solutions Group is sending me for the examination and paying for the examination. I fully understand the wording of this document.

Should an accident occur while on assignment, I understand that a drug/alcohol screen will be required immediately. Additionally, I understand that when my employer has a valid suspicion of my drug or alcohol use and a further belief that my poor performance is directly related to such drug or alcohol use, then I may be subject to a random drug/alcohol test. Under such circumstances, I consent and authorize my participation in such limited random drug/alcohol testing, and agree to hold all parties involved harmless in the event that any test shows a positive result. My refusal to submit to the drug or alcohol testing under the terms and conditions outlined hereinabove will be grounds for immediate termination. Provided further. that should the employee work in San Francisco, CA or Berkley, CA, this provision regarding random drug testing is inapplicable or restricted by ordinance. In the event the lab results are positive, I agree to pay lab fees incurred. Any positive drug test result may result in my immediate termination.

I,

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

  • Pre-Employment
  • Post-Hire
  • For Cause/Suspicion
  • Post, Accident
  • Random
  • Promotion/Job Transition

My signature below indicates my acknowledgment that, should a drug/alcohol test be requested or be appropriate under the above drug/alcohol screen authorization and consent, and if I fail a test or refuse to submit the required blood or urine sample for the authorized screen, such failure or refusal, whatever reason, will be grounds for termination.

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Direct Deposit Authorization

I authorize TPS Solutions Inc., dba The Staffing Solutions Group to credit the attached bank account for my wages earned. In the event that an error has been made and I am overpaid, I hereby authorize TPS Solutions Inc., dba The Staffing Solutions Group to deduct such monies from my account to correct such errors. Additionally, it is my sole obligation to inform TPS Solutions Inc., dba The Staffing Solutions Group of any changes to my direct deposit account information. I understand that if I fail to notify TPS Solutions., dba The Staffing Solutions Group in a timely manner following a change to my account information, any wages owed to me will be delayed until the next pay period after the account changes are received and processed by TPS Solutions Inc., dba The Staffing Solutions Group. I agree to waive any claims related to this delay in wage payment that could arise under any applicable statute, ordinance, or other law.

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Please check one. Funds Cannot Be Split.
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Please verify routing number with your bank. The routing numbers may sometimes be different than what appears on your bank.

**Please notify payroll immediately if you close or change bank accounts**

General Safety Rules

The company has developed these safety rules patterned after the Federal and State OSHA requirements. Read and become familiar with these rules and the other safety rules that apply to your job.The company has developed these safety rules patterned after the Federal and State OSHA requirements. Read and become familiar with these rules and the other safety rules that apply to your job.

  1. Report any injury to your employer/supervisor immediately.
  2. Report any observed unsafe condition to your employer/supervisor.
  3. Horseplay is prohibited at all times.
  4. The drinking of alcoholic beverages is not permitted on the job. Any employee discovered under the influence of alcohol or drugs will not be permitted to work.
  5. Appropriate clothing and footwear must be worn on the job at all times.
  6. You should not perform any task unless you are trained to do so and are aware of the hazards associated with that task.
  7. 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.
  8. Learn safe work practices. When in doubt about performing a task safely, contact your supervisor for instruction and training.
  9. Never remove or by-pass safety devices.
  10. Learn where fire extinguishers and first aid kits are located.
  11. Maintain a general condition of good housekeeping in all work areas at all times.
  12. Be alert to hazards that could affect you and your fellow employees.
  13. Always perform your assigned task in a safe and proper manner; do not take short cuts. The taking of shortcuts and the ignoring of established safety rules are the leading causes of employee injury.

I certify that I have read and understand and will abide by the above-listed safety rules. Failure to do so may be grounds for termination and may disqualify my insurance benefits. I also certify that I was given the opportunity to ask questions relating to any and all of the above-listed rules and policies and that my questions were answered by a representative of the company.

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Sexual Harassment Policy

Sexual harassment is illegal. It is the policy of TPS Solutions Inc., dba The Staffing Solutions Group (TSSG) that all employees be able to enjoy a work environment free from all forms of unlawful discrimination, including sexual harassment. Sexual harassment damages employee morale, and hurts the employment relationship. Anyone engaging in sexual harassment will be disciplined. This discipline may include termination.

What is Sexual Harassment?

It is unwanted sexual advances, statements of a sexual nature, or physical conduct of a sexual nature. Sexual harassment includes gender-based harassment of a person the same sex as the harasser.

Investigation and Complaint Procedures

If you believe that you have been subjected to harassment by a supervisor, management official, fellow employee, customer, client, vendor or any other person in connection with your employment at TSSG, you should promptly report any incidents to your supervisor. Whenever possible, clearly ask the harasser to stop, as a simple confrontation often will end the situation. If, in spite of your efforts, the harassment continues, if you believe that your immediate supervisor is involved in the harassment, or that a previously reported complaint has not been satisfactorily resolved, you should contact your TSSG office.

TSSG will thoroughly and promptly investigate all sexual harassment complaints. Information received will remain as confidential as possible under the circumstances. If TSSG determines that the complaint is valid, it will correct the situation, which, where possible, may include moving you to a different assignment if you wish. Where possible, TSSG will also discipline the person committing the harassment, which may include termination. If TSSG determines that you have filed a false claim, TSSG may also discipline you, which may include your termination.

Protect Against Retaliation

The filling of a sexual harassment complaint or the participation in a sexual harassment investigation will not affect your employment. Similarly, your employment will not be affected if you file a charge with or participate in a sexual harassment investigation conducted by an outside agency, such as the Equal Employment Opportunity Commission and/or a local Human Rights Agency.

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Form W-4

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 $1050 and includes more than $350 of unearned income (for example, interest and dividends).

Exemptions.

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 supplement wages greater than $1,000,000

Basic Instructions.

If you aren’t exempt, complete the Personal Allowances Worksheet below. The worksheets on page 8 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 fiat amount or percentage 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 a 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 o all jobs using worksheets from only one 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 $130000 (Single) or $180000 (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 Allowance Worksheet (Keep for your records)

  • You’re single and have only one job; or
  • You’re married, have onlyu 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 $1500 or less.

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)

(see conditions under Head of household above)

Note: Do not include child support payments, See Pub, 503, Child and Dependent Care Expenses, for details.

  • If your total income will be less than $70000 ($100000 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 $70000 and $84000 ($100000 and $119000 if married), enter “1” for each eligible child.

For accuracy, complete all worksheets that apply.

  • If you plan to itemize or claim adjustments to income and want to reduce your withholding, see Deductions and Adjustments Worksheet on page 8.
  • 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 exceeds $50000 ($20000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 8 to avoid having too little tax withheld.
  • If neither of the above situations applies, stop here and enter the number from the line H on line 5 of Form W-4 below.

Employee's Withholding Allowance Certificate

(from line H above or from the applicable worksheet on page 8)
  • Last year I had a right to a refund of all federal income tax withheld because I expect to have no tax liability and
  • This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
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TPS Solutions Inc., dba The Staffing Solutions Group, 2295 De La Cruz Blvd., Santa Clara, CA 95050

(optional)

Employment Eligibility Verification

Department of Homeland Security

U.S Citizenship and Immigration Services
USCIS Form I-9
OMB No, 1615-0047
Expires 08/31/2019

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 Attention

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.

Some aliens may write "N/A" in the expiration date field. (See instructions)

An Alien Registration Number/USCIS Number or Form I-94 Admission Number or Foreign Passport Number.

Do Not Write In This Space

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(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

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NOTICE TO EMPLOYEE - Labor Code section 2810.5

(including meal or lodging allowance)

(PRINT NAME of Employee)

(SIGNATURE of Employee) - Click below and sign your name on the line as you normally would.
(Date provided to employee)

The employee’s signature on this notice constitutes acknowledgement of receipt. In accordance with an employer’s general record keeping requirements under the law, it is the employer’s obligation to ensure that the employment and wage-related information provided on this notice is accurate and complete. Furthermore, the employee’s signature acknowledging receipt of this notice does not constitute a voluntary written agreement as required under the law between the employer and employee in order to credit any meals or lodging against the minimum wage. Any such voluntary written agreement must be evidenced by a separate document.

DOCUMENT UPLOAD

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ELECTRONIC SIGNATURE

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By signing above I am certifying that all information on this application is true and correct, including the W4 and I9 forms, and that signature will be considered the same as my actual signature.

Congratulations on completing the application part of this process.

If you haven’t heard from the Staffing Solutions Group within three days, you may call your nearest office. For a list of offices visit: http://thessg.com/contact-us/