How to Complete New-Hire Paperwork

Transcription

How to Complete New-Hire Paperwork
The new-hire paperwork listed below is mandatory and should be completed by the new employee on or before their
first day of employment. All of the items listed below must be submitted to Corporate Payroll no later than THREE
DAYS after employment begins. Please pay special attention to check the appropriate boxes and obtain signatures
where required. New employee wages may not be paid until all paperwork is submitted and is complete. The
Corporate Payroll department provides New-Hire Packets. Each branch should keep 3-5 packets on hand
**Starred items are those which must be signed by the hiring manager.
A long-distance phone Access Code should be requested via e-mail from the Corporate Payroll department.
A Varnett log in and password should be requested via e-mail from the Corporate Payroll department.
**Payroll Change Notice must have the top section and hire section completed and signed by an authorized
manager.
The W-4 form (and Arizona W-4) must be filled out listing the number of exemptions and signed by the new
employee.
The Employment Eligibility Verification form must have Section 1 completed by the employee. Mark the
applicable resident statement box and have the new employee sign the form.
**A manager must complete Section 2 of the Employment Eligibility Verification form: Choose List A or Lists
B & C. The manager must verify that documents are genuine. A list of acceptable documents is provided
along with the main form.
**For certification, the manager must sign section 2 of the Employment Eligibility Verification form.
The Pre-Employment Application must be thoroughly completed. All questions at top of the last page must be
answered.
** The Pre-Employment Application must have signatures of at least two interviewing managers.
**Employment Agreement not in packet; emailed only. First page must be completed. There’s a place on the
second to last page that needs to be filled in by the EE. Last page must be signed by Branch Manager and
EE.
**Job Description sign off sheet. EE should sign the job description that corresponds with the job hired for.
They should keep copy. Manager must sign also. Return with rest of packet.
Only employees that are employed in the State of Texas should sign employers Notice to Texas Employees.
**Wage Deduction Authorization must have applicable items checked on the bottom and signed by the
employee and hiring manager. If a Policy Manual is needed, contact the Corporate Payroll department.
**Waiver of Company Responsibility must be signed by the employee and witnessed by a Redi Carpet
manager.
The employee must sign the Employee Acknowledgement form.
The Employee Data sheet employee must complete the form. This includes checking Smoking and Disability.
Direct Deposit information must be provided for depositing wages. Prospects who cannot acquire a banking
account will not be hired. Wages will be withheld until such information is provided to Corporate Payroll.
Accounts can be either Checking or Savings.
All Surveys taken should be included with other paperwork sent to Corporate Payroll.
**The Safety Orientation Checklist must be completed and signed by the employee and hiring manager.
Forklift training is for warehouse only. Any employee or manager who will be driving a forklift must complete
the Forklift Training Video and Certificate.
Certification must be complete and submitted with paperwork.
The employee must complete the Consumer Report Disclosure and Release of Information Authorization
in order to submit to Verifications for Background Investigation. This information should already have been
complete as stated in the above Hiring Process.
A Background Investigation: Completed Final Report must be included from Verifications indicating the
results from the background investigation. Discrepancies between information on the background
investigation and the Employment Application must be addressed. Any misrepresentation, falsification, or
material omission in any of this information may result in the termination of the new employee. All
discrepancies should be discussed with the President or CEO.
Employee’s Name
Position
Interviewing/Hiring Manager please complete:
To set up a new employee in the system, send an email to newhire@redicarpet.com with their Full Name, Job Title, & Location. If they will be using their cell number for work, please include it as well. Please indicate if they need a long‐distance code issued.  Long-distance Telephone Access Code #
_
_
 Current Telephone Extension List
 Varnet System
User: ___________________
Password _
______
 Redi Carpet Websites
User: ___________________
Password _
______
(www.redicarpet.com,redi-link,halogen,etc.)
 Email Address
_____________________________________
Password ___ __________
 Keys issued: Interior, Exterior Bldg. Exterior Warehouse
Hiring Manager Signature:
Date:
Payroll Department must receive in Packet for processing:
 Payroll Change Notice
 W-4 Form
State W-4 (if applicable)
 Pre-Employment Application (2 signatures on last page)
 I-9 Form**
**signed by Mgr. and Employee
 Employment Agreement **signed
by Manager and Employee
 Job Description **signed
 Employer’s Notice to New Texas Employees (Texas only)
 Wage Deduction Authorization Form **signed by Manager and Employee
 Waiver of Company Responsibility for Collision Damage **signed
 Auto Insurance
(all employees whose personal car is used for business purposes (Account Managers)
 Employee Acknowledgement Form
 Employee Data Sheet
 Direct Deposit Form (w/void check—Deposit slip not acceptable)
 Step One Survey
(all prospects qualifying for office interview)
 Profile XT Survey
(Managers)
 Employee Safety Orientation & Checklist
(all items must be reviewed, checked, and form signed)
 OSHA Compliant Forklift Training Completed
(Warehouse only)
(Certification must be completed and submitted with New Hire Packet)
 Consumer Report / Investigative Report Disclosure and Release form
Background
Investigation
 Employment Verification (all new hires)
 Academic (all new hires except warehouse)
 Driving Record (when applicable)
 Criminal Background (all new hires)
***Insurance packet will be sent to the office for the new employee in approximately 30 days.
Payroll Personnel Signature:
Date
Branch Location: ___________________________
Date: ________________________
Employee’s Name: ___________________________
Title: ________________________
Hire Date: ________________
Change From: _____________
Last Pay Raise Date: ________________
Per _______
To: ____________ Per ______________
Effective Date: _________________________
Reason for Change:

(no retroactive Annual Review Effective Dates)
Annual Review Merit Increase
Negotiated Increase
Salary reduction
Position Change from _____________ to ____________
Other
Starting Pay Rate: _____________
Per ________
Change to ‘Commission Only’ after ________________
Resignation
Lay Off
Discharge
Starting Date: _________________
(attach pay schedule)
Effective Date: ______________
(attach Resignation letter)
Explanation: ___________________________________________________________________
Last Date of Work: ___________________
Return to Work Date: ________________ (approx.)
Reason: ______________________________________________________________________
Department Head/Branch Manager: _________________________________________________
Chief Executive Officer:
_________________________________________________
Chief Operating Officer:
_________________________________________________
07/01/05
Form W-4 (2012)
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 2012 expires
February 18, 2013. 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 cannot claim
exemption from withholding if your income exceeds
$950 and includes more than $300 of unearned
income (for example, interest and dividends).
Basic instructions. If you are not 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 2012. See Pub. 505, especially if your earnings
exceed $130,000 (Single) or $180,000 (Married).
Future developments. The IRS has created a page
on IRS.gov for information about Form W-4, at
www.irs.gov/w4. Information about any future
developments affecting Form W-4 (such as
legislation enacted after we release it) will be posted
on that page.
Personal Allowances Worksheet (Keep for your records.)
A
Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . .
A
• You are single and have only one job; or
Enter “1” if:
B
• You are married, have only one job, and your spouse does not work; or
. . .
• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.
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
Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . .
D
Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . .
E
Enter “1” if you have at least $1,900 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.)
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 $61,000 ($90,000 if married), enter “2” for each eligible child; then less “1” if you have three to
seven eligible children or less “2” if you have eight or more eligible children.
{
B
C
D
E
F
G
}
• If your total income will be between $61,000 and $84,000 ($90,000 and $119,000 if married), enter “1” for each eligible child . . .
G
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
• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
For accuracy,
and Adjustments Worksheet on page 2.
complete all
• 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 $40,000 ($10,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to
worksheets
avoid having too little tax withheld.
that apply.
• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.
H
{
Separate here and give Form W-4 to your employer. Keep the top part for your records.
Form
W-4
Department of the Treasury
Internal Revenue Service
1
Employee's Withholding Allowance Certificate
OMB No. 1545-0074
▶ 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.
2
Last name
Your first name and middle initial
Home address (number and street or rural route)
3
Single
Married
2012
Your social security number
Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
City or town, state, and ZIP code
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
6
7
Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)
5
6 $
Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . .
I claim exemption from withholding for 2012, 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.)
8
Date ▶
▶
Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
9 Office code (optional)
Cat. No. 10220Q
10
Employer identification number (EIN)
Form W-4 (2012)
Page 2
Form W-4 (2012)
Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
1
2
3
4
5
6
7
8
9
10
Enter an estimate of your 2012 itemized deductions. These include qualifying home mortgage interest,
charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and
miscellaneous deductions . . . . . . . . . . . . . . . . . . . . . . . . .
$11,900 if married filing jointly or qualifying widow(er)
Enter:
$8,700 if head of household
. . . . . . . . . . .
$5,950 if single or married filing separately
Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . .
Enter an estimate of your 2012 adjustments to income and any additional standard deduction (see Pub. 505)
Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to
Withholding Allowances for 2012 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . .
{
}
Enter an estimate of your 2012 nonwage income (such as dividends or interest) . . . . . . . .
Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . .
Divide the amount on line 7 by $3,800 and enter the result here. Drop any fraction . . . . . . .
Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . .
Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet,
also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1
1
$
2
$
3
4
$
$
5
6
7
8
9
$
$
$
10
Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)
Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
1
2
Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if
you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more
than “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
1
2
If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . .
3
Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional
withholding amount necessary to avoid a year-end tax bill.
4
5
6
7
8
9
Enter the number from line 2 of this worksheet . . . . . . . . . .
4
Enter the number from line 1 of this worksheet . . . . . . . . . .
5
Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . .
Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . .
Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . .
Divide line 8 by the number of pay periods remaining in 2012. For example, divide by 26 if you are paid
every two weeks and you complete this form in December 2011. Enter the result here and on Form W-4,
line 6, page 1. This is the additional amount to be withheld from each paycheck . . . . . . . .
Table 1
Married Filing Jointly
If wages from LOWEST
paying job are—
Enter on
line 2 above
6
7
8
$
$
9
$
Table 2
All Others
If wages from LOWEST
paying job are—
Married Filing Jointly
Enter on
line 2 above
$0 - $5,000
0
$0 - $8,000
0
1
5,001 - 12,000
8,001 - 15,000
1
2
12,001 - 22,000
15,001 - 25,000
2
3
22,001 - 25,000
25,001 - 30,000
3
4
25,001 - 30,000
30,001 - 40,000
4
5
30,001 - 40,000
40,001 - 50,000
5
6
40,001 - 48,000
50,001 - 65,000
6
7
48,001 - 55,000
65,001 - 80,000
7
8
55,001 - 65,000
80,001 - 95,000
8
9
65,001 - 72,000
95,001 - 120,000
9
10
72,001 - 85,000
120,001 and over
10
85,001 - 97,000
11
12
97,001 - 110,000
13
110,001 - 120,000
14
120,001 - 135,000
15
135,001 and over
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this
form to carry out the Internal Revenue laws of the United States. Internal Revenue Code
sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your
employer uses it to determine your federal income tax withholding. Failure to provide a
properly completed form will result in your being treated as a single person who claims no
withholding allowances; providing fraudulent information may subject you to penalties. Routine
uses of this information include giving it to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions
for use in administering their tax laws; and to the Department of Health and Human Services
for use in the National Directory of New Hires. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal
laws, or to federal law enforcement and intelligence agencies to combat terrorism.
If wages from HIGHEST
paying job are—
$0
70,001
125,001
190,001
340,001
- $70,000
- 125,000
- 190,000
- 340,000
and over
Enter on
line 7 above
$570
950
1,060
1,250
1,330
All Others
If wages from HIGHEST
paying job are—
$0
35,001
90,001
170,001
375,001
- $35,000
- 90,000
- 170,000
- 375,000
and over
Enter on
line 7 above
$570
950
1,060
1,250
1,330
You are not required to provide the information requested on a form that is subject to the
Paperwork Reduction Act unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long as their contents may
become material in the administration of any Internal Revenue law. Generally, tax returns and
return information are confidential, as required by Code section 6103.
The average time and expenses required to complete and file this form will vary depending
on individual circumstances. For estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we would be happy to hear from you.
See the instructions for your income tax return.
B. PRODUCT SELECTION - Application for (check all that apply):
ENROLLMENT FORM - Group Life and Disability
Group Life and Disability Insurance products provided by Unimerica Insurance Company or UnitedHealthcare Insurance Company
Use this form to apply for or to make changes to the applicable coverages listed below.
Late applicants are subject to Evidence of Insurability.
The following information is required to accurately enroll you and your dependents in the applicable coverage(s) requested.
Missing information will delay enrollment processing.
Name
Address, including zip code
Social Security Number
Gender
Date of birth
Hire date (not needed if initial new case enrollment)
Class (if applicable)
Subgroup (if applicable)
Annual salary (required for salary based benefits)
Tobacco use (if benefits/rates are based on non-tobacco,
tobacco use)
Supplemental Benefits:
Amount of current coverage
Amount of new coverage requested
Total amount of coverage after adding current and new
coverage amounts
Dependent Benefits:
Dependent name and relationship to Employee
Dependent date of birth
Gender
Handicapped information (if applicable)
Student information (full-time, part-time, date or enrollment
and name of each school)
A. EMPLOYEE INFORMATION
A. EMPLOYEE INFORMATION
Enroll
Cancel
Address Change
Name Change
Last Name First Name M.I.
Other
Date
Street Address
Apt No.
City
Gender
State
Date of Birth
M
F
Zip Code
Single
Home Phone
Work Phone
(
(
)
Employer or Group Name
Division/Location
Annual Salary
)
Subgroup Code
If applicable, have you or your dependent(s) used tobacco of any kind during the last twelve months?
Employee
Dependent Spouse
Dependent Child
If Yes, who?
100-8652
UIC, UHIC Facets Enrollment Form (4/09)
Job Title
Yes
No
Married
B. PRODUCT SELECTION – Application for (check all that apply):
Employee Hire Date: ________________________________
Basic Life and AD&D Insurance:
Basic Life Insurance
Basic Accidental Death and Dismemberment (AD&D)
Employee Supplemental Life and AD&D Insurance: Increases may be subject to Evidence of Insurability
Employee Supplemental Life:
Employee Supplemental AD&D:
Current Amount of Coverage: $_____________________________
Increase coverage by: $____________________________
Decrease coverage by: $___________________________
Total Amount of Coverage: $_____________________________
Total Amount of Coverage: $_______________________________
Beneficiary Designation: Beneficiary information should be maintained by the Employer on a separate Beneficiary form.
Basic Dependent Life and AD&D Insurance:
Basic Dependent Life Spouse: $ _____________________ amount
Basic Dependent AD&D Spouse: $ ____________________ amount
Basic Dependent Life Child(ren): $____________________ amount
Basic Dependent AD&D Child(ren): $ __________________ amount
Dependent Supplemental Life and AD&D Insurance: Increases may be subject to Evidence of Insurability
Dependent Spouse Supplemental Life:
Dependent Spouse AD&D:
Dependent Child Supplemental Life:
Dependent Child AD&D:
Disability Insurance:
Short Term Disability (STD)
Long Term Disability (LTD)
C. INFORMATION FOR DEPENDENT COVERAGE (List all family members to be covered)
Last name
First Name
M.I.
Date of Birth
Relationship
If child is over age 19, please
indicate status and/or school
Gender
Check one
Handicapped
Student at
M
F
Enroll
Cancel
Waive
Change
Handicapped
Student at
M
F
Enroll
Cancel
Waive
Change
Handicapped
Student at
M
F
Enroll
Cancel
Waive
Change
Handicapped
Student at
M
F
Enroll
Cancel
Waive
Change
D. SIGNATURE (This form must be signed)
I understand that by signing this form I am authorizing the necessary premium deductions from my salary or wages for the coverage(s) I have selected.
X __________________________________________________________________________
__________________________
Signature of Employee
Date
E. EMPLOYER USE ONLY
Initial enrollment following Date of Hire
Late Applicant
Employee Effective Date
(mm/dd/yyyy)
D. SIGNATURE (This form must be signed)
100-8652
UIC, UHIC Facets Enrollment Form (4/09)
Signed for Employer by
Group Number
Beneficiary Form
Group Term Life Insurance
Policy Holder:
Individual Covered Person:
SS#:
Note: This Beneficiary Designation cancels any prior beneficiary designation and shall be effective on the
date received by the Company.
THE BENEFICIARY FOR THE POLICY SHALL BE:
a)
Primary Beneficiary
Percentage
Relationship
Address
to Insured
b)
Contingent Beneficiary
Percentage
Relationship
Address
to Insured
INSURED:
WITNESS
Signature
Print Name
Date
Date
EMPLOYMENT AGREEMENT
This Employment Agreement ("Agreement") is entered into between Redi-Carpet Sales
of Georgia, LLC. ("Company"), and _______________ ("Employee"), and is effective as of
_______________.
1.
Employment. Company employs Employee upon the terms and conditions set
forth in this Agreement.
2.
Duties and Responsibilities.
2.1 Extent of Service. Employee will, during the term of this Agreement, devote
the time, attention, energies and business efforts to his or her duties as an employee of Company
as are reasonably necessary to carry out the duties specified in Paragraph 2.2 of this Agreement.
Employee will not, during the term of this Agreement, engage in any other business activity
(whether or not such business activity is pursued for gain, profit or other pecuniary advantage) if
such business activity would impair Employee's ability to carry out his or her duties under this
Agreement.
2.2. Position and Duties. Employee will serve Company as a _______________,
and will perform, faithfully and diligently, the duties and functions relating to this position.
2.3 Employee shall provide Company with all information, suggestions and
recommendations regarding Company’s business, of which Employee has knowledge, will be of
benefit to Company.
3.
Compensation and Other Benefits.
3.1 Compensation. Employee's compensation is set forth in Exhibit A.
Employee's compensation may be adjusted as Company considers appropriate.
3.2 Other Benefits. As long as Employee is employed by Company, Employee
may be eligible to participate in any of Company's benefits in accordance with any plan
documents and Company's policies and procedures. Employee will be entitled to vacation,
holidays, and other paid or unpaid leaves of absence, in accordance with Company's policies and
procedures.
4.
Termination.
Employee understands and agrees that the employment
relationship is at-will. Accordingly, either Company or Employee has the right to terminate the
employment relationship with or without cause, reason or advance notice.
5.
Intellectual Property.
5.1 Confidential Information. During the employment relationship, Company
will provide “Confidential Information” to Employer. During and after the employment
relationship, Employee will maintain the confidentiality of and not disclose "Confidential
Information" received from Company. "Confidential Information" means all technical and
business information, including financial statements and related books and records, computer
disks, electronic files, personnel records, handbooks, manuals, correspondence, marketing plans,
customer files, customer information, customer lists, and arrangements with customers and
suppliers.
5.2
Former Employers.
Employee acknowledges that Company expects
Employee to respect and safeguard the trade secrets and confidential information of any and all
former employers. Employee will not disclose to Company, use in Company’s business, or
cause Company to use, any information or material that is confidential to any former employer,
unless such information is no longer confidential or Company or Employee has obtained the
written consent of such former employer to do so.
6.
Agreement Not to Compete. Employee hereby recognizes and acknowledges
that: (a) in Employee’s employment capacity with Company, Employee will be given knowledge
of, and access to, the Confidential Information (as described above); (b) in the event that
Employee was to enter into competition with Company, Employee’s knowledge of such
Confidential Information would be of invaluable benefit to a competitor of Company, and could
cause irreparable harm to Company’s business interest; and (c) Employee’s consent and
agreement to enter into the noncompetition provisions and covenants set forth herein is an
integral condition of this Agreement, without which Company would not have agreed to provide
Confidential Information to Employee.
Accordingly, in consideration for Employee’s
employment, compensation, benefits, access to and entrustment of Confidential Information, and
the goodwill, training and experience provided to Employee, Employee hereby covenants,
consents and agrees that during the employment relationship, and for a period of twelve (12)
months after Employee’s employment is terminated for any reason, Employee shall not directly
or indirectly, acting alone or in conjunction with others, for Employee’s own account or for the
account of others, including, without limitation, as an officer, director, partner, joint venturer,
employee, promoter, consultant, agent, representative, or otherwise:
(a)
Solicit, canvass, or accept any fees or business from any Customer or Prospective
Customer (as limited below) of Company for himself or herself or any other
person or entity engaged in a “Similar Business to Company” (as defined below);
(b)
Engage or participate in any Similar Business to Company within the counties
and/or parishes listed on Exhibit B (referred to herein as the “Restricted Area”);
(c)
Request or advise any service provider, supplier, or customer to reduce or cancel
any business that it may transact with Company;
(d)
Make any statement or perform any act intended to advance an interest of an
existing or prospective competitor of the Company or any of its affiliated entities
in any way that demonstrably injures the reputation, goodwill or any other
business interest of Company.
D:\NewHire\Employment Agreement Georgia .doc
-2-
The terms Customer and Prospective Customer shall be limited to those persons and
companies solicited or serviced by Employee during Employee’s employment with Company.
The business of Company is defined as providing installation of flooring materials to the
multi-family housing industry. For purposes of this Agreement, “Similar Business to Company”
means any business or other enterprise that is competitive with the current or planned businesses,
services or operations of the Company or any of its affiliated entities at the time of termination of
Employee’s employment.
Employee hereby agrees that the limitations set forth in this Section 6 on Employee’s
rights to compete with Company after his or her termination of employment are reasonable and
necessary for the protection of Company. In this regard, Employee specifically agrees that such
limitations as to the period of time, Restricted Area and types and scopes of restriction on his or
her activities, as specified above, are reasonable and necessary to protect the goodwill and other
business interests of Company. However, should the time period, the Restricted Area or any
other non-competition provision set forth herein be deemed invalid or unenforceable in any
respect, then Employee acknowledges and agrees that, as set forth in Section 8 to such time
period, Restricted Area or other non-competition provision in order to protect Company’s
reasonable business interests to the maximum permissible extent.
7.
Non-Solicitation of Employees. While employed by Company and for a period
of one (1) year from the date of termination of Employee's employment with Company for any
reason, Employee shall not directly or indirectly solicit, induce or encourage any employee(s) of
Company to terminate their employment with Company or to accept employment with any
competitor, supplier or client of Company, nor shall Employee cooperate with any others in
doing or attempting to do so. As used herein, the term "solicit, induce or encourage" includes,
but is not limited to, (i) initiating communications with a Company employee relating to possible
employment, (ii) offering bonuses or additional compensation to encourage Company employees
to terminate their employment with Company and accept employment with a competitor,
supplier or client of the Company, or (iii) referring Company’s employees to personnel or agents
employed by competitors, suppliers or clients of Company.
8.
Remedies. In the event of any pending, threatened or actual breach of any of the
covenants or provisions of Sections 5, 6 and 7, it is understood and agreed by Employee that the
remedy at law for a breach of any of the covenants or provisions of these sections may be
inadequate and, therefore, Company shall be entitled to a restraining order or injunctive relief
from any court of competent jurisdiction, in addition to any other remedies at law and in equity.
In the event that Company seeks to obtain a restraining order or injunctive relief, Employee
hereby agrees that Company shall not be required to post any bond in connection therewith.
Should a court of competent jurisdiction declare any provision of Sections 5, 6 and 7 to be
unenforceable due to an unreasonable restriction of duration or geographical area, or for any
other reason, such court is hereby granted the consent of each of Employee and Company to
reform such provision and/or to grant the Company any relief, at law or in equity, reasonably
necessary to protect the reasonable business interests of Company or any of its affiliated entities.
Employee hereby acknowledges and agrees that all of the covenants and other provisions of
Sections 5, 6 and 7 are reasonable and necessary for the protection of the Company’s reasonable
-3-
business interests. Employee hereby agrees that if the Company prevails in any action, suit or
proceeding with respect to any matter arising out of or in connection with Sections 5, 6 and 7,
Company shall be entitled to all equitable and legal remedies, including, but not limited to,
injunctive relief and compensatory damages.
9.
Return of Property. Upon termination of the employment relationship between
Company and Employee, Employee agrees to return all Company property, including, but not
limited to, documents, keys, credit cards, access cards, files, computer disks, electronic files,
handbooks, manuals, records, or other items relating to the Company’s business.
10.
Controlling Law. The execution, validity, interpretation and performance of this
Agreement will be governed by the law of the State of Texas, without regard to conflict of law
principles. The exclusive venue for any lawsuit relating to or arising under this Agreement shall
be Harris County, Texas.
11.
Jury Trial Waiver. Employee and Company irrevocably waive their right to
trial by jury on any claim, dispute, action, proceeding or counter-claim, whether at law or in
equity, arising out of the employment relationship and/or termination of the relationship. This
waiver includes all claims and causes of action based on federal, state, or local law, including,
without limitation, contract claims, tort claims, claims of discrimination or harassment, and
wrongful termination claims under state law, common law or under Title VII of the Civil Rights
Act of 1964, the Civil Rights Act of 1991, the Americans with Disabilities Act, the Age
Discrimination in Employment Act, the Family and Medical Leave Act, the Fair Labor Standards
Act, or the Older Worker's Benefit Protection Act, or any other applicable statute. This waiver
does not affect any remedies available under any laws; rather, the parties waive only the right to
a trial by jury and will present any controversy involving Company and Employee in a bench
trial to a judge.
12.
Amendments. This agreement may be changed or modified only by an
agreement in writing signed by Employee and Company.
13.
Separability. If any provision of the Agreement is rendered or declared illegal or
unenforceable by reason of any existing or subsequently enacted legislation or by the decision of
any arbitrator or by decree of a court of last resort, all other provisions of this Agreement will
remain in full force and effect.
14.
Assignments. Company may assign (whether by operation of law or otherwise)
this Agreement. In the event of any assignment of this Agreement, all covenants, conditions and
provisions in this Agreement will inure to the benefit of and be enforceable against Company's
successors and assigns. The rights and obligations of Employee under this Agreement are
personal to him or her, and no such rights, benefits or obligations will be subject to voluntary or
involuntary alienation, assignment or transfer.
-4-
REDI-CARPET SALES OF GEORGIA, LLC.
By:
Name:
Title:
"EMPLOYEE"
______________________________________
Name
-5-
Exhibit B “Restricted Area”
Atlanta
Counties
Cobb
Cherokee
Bartow
Paulding
Fulton
Clayton
Dekalb
Henry
Gwinnett
Rockdale
Forsyth
Coweta
Douglass
Carroll
Pickens
Walton
Spalding
Columbus, GA
Harris
Muscogee
Chattahoochee
Macon, GA
June
Bibb
Twiggs
Peach
Houston
Athens, GA
Clark
Madison
Oconee
Chattanooga, TN
Marion
Hamilton
OMB No. 1615-0047; Expires 06/30/09
Form I-9, Employment
Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Instructions
Please read all instructions carefully before completing this form.
Anti-Discrimination Notice. It is illegal to discriminate against
any individual (other than an alien not authorized to work in the
U.S.) in hiring, discharging, or recruiting or referring for a fee
because of that individual's national origin or citizenship status. It
is illegal to discriminate against work eligible individuals.
Employers CANNOT specify which document(s) they will accept
from an employee. The refusal to hire an individual because the
documents presented have a future expiration date may also
constitute illegal discrimination.
What Is the Purpose of This Form?
The purpose of this form is to document that each new
employee (both citizen and non-citizen) hired after November
6, 1986 is authorized to work in the United States.
When Should the Form I-9 Be Used?
All employees, citizens and noncitizens, hired after November
6, 1986 and working in the United States must complete a
Form I-9.
Filling Out the Form I-9
Section 1, Employee: This part of the form must be
completed at the time of hire, which is the actual beginning of
employment. Providing the Social Security number is
voluntary, except for employees hired by employers
participating in the USCIS Electronic Employment Eligibility
Verification Program (E-Verify). The employer is
responsible for ensuring that Section 1 is timely and
properly completed.
Preparer/Translator Certification. The Preparer/Translator
Certification must be completed if Section 1 is prepared by a
person other than the employee. A preparer/translator may be
used only when the employee is unable to complete Section 1
on his/her own. However, the employee must still sign
Section 1 personally.
Section 2, Employer: For the purpose of completing this
form, the term "employer" means all employers including
those recruiters and referrers for a fee who are agricultural
associations, agricultural employers or farm labor contractors.
Employers must complete Section 2 by examining evidence
of identity and employment eligibility within three (3)
business days of the date employment begins. If employees
are authorized to work, but are unable to present the required
document(s) within three business days, they must present a
receipt for the application of the document(s) within three
business days and the actual document(s) within ninety (90)
days. However, if employers hire individuals for a duration of
less than three business days, Section 2 must be completed at
the time employment begins. Employers must record:
1.
2.
3.
4.
5.
Document title;
Issuing authority;
Document number;
Expiration date, if any; and
The date employment begins.
Employers must sign and date the certification. Employees
must present original documents. Employers may, but are not
required to, photocopy the document(s) presented. These
photocopies may only be used for the verification process and
must be retained with the Form I-9. However, employers are
still responsible for completing and retaining the Form I-9.
Section 3, Updating and Reverification: Employers must
complete Section 3 when updating and/or reverifying the Form
I-9. Employers must reverify employment eligibility of their
employees on or before the expiration date recorded in Section
1. Employers CANNOT specify which document(s) they will
accept from an employee.
A. If an employee's name has changed at the time this
form is being updated/reverified, complete Block A.
B. If an employee is rehired within three (3) years of the
date this form was originally completed and the
employee is still eligible to be employed on the same
basis as previously indicated on this form (updating),
complete Block B and the signature block.
C. If an employee is rehired within three (3) years of the
date this form was originally completed and the
employee's work authorization has expired or if a
current employee's work authorization is about to
expire (reverification), complete Block B and:
1. Examine any document that reflects that the
employee is authorized to work in the U.S. (see
List A or C);
2. Record the document title, document number and
expiration date (if any) in Block C, and
3. Complete the signature block.
Form I-9 (Rev. 06/05/07) N
What Is the Filing Fee?
There is no associated filing fee for completing the Form I-9.
This form is not filed with USCIS or any government agency.
The Form I-9 must be retained by the employer and made
available for inspection by U.S. Government officials as
specified in the Privacy Act Notice below.
USCIS Forms and Information
To order USCIS forms, call our toll-free number at 1-800-8703676. Individuals can also get USCIS forms and information
on immigration laws, regulations and procedures by
telephoning our National Customer Service Center at 1-800375-5283 or visiting our internet website at www.uscis.gov.
Photocopying and Retaining the Form I-9
A blank Form I-9 may be reproduced, provided both sides are
copied. The Instructions must be available to all employees
completing this form. Employers must retain completed Forms
I-9 for three (3) years after the date of hire or one (1) year
after the date employment ends, whichever is later.
Submission of the information required in this form is
voluntary. However, an individual may not begin employment
unless this form is completed, since employers are subject to
civil or criminal penalties if they do not comply with the
Immigration Reform and Control Act of 1986.
Paperwork Reduction Act
We try to create forms and instructions that are accurate, can
be easily understood and which impose the least possible
burden on you to provide us with information. Often this is
difficult because some immigration laws are very complex.
Accordingly, the reporting burden for this collection of
information is computed as follows: 1) learning about this
form, and completing the form, 9 minutes; 2) assembling and
filing (recordkeeping) the form, 3 minutes, for an average of
12 minutes per response. If you have comments regarding the
accuracy of this burden estimate, or suggestions for making
this form simpler, you can write to: U.S. Citizenship and
Immigration Services, Regulatory Management Division, 111
Massachusetts Avenue, N.W., 3rd Floor, Suite 3008,
Washington, DC 20529. OMB No. 1615-0047.
The Form I-9 may be signed and retained electronically, as
authorized in Department of Homeland Security regulations
at 8 CFR § 274a.2.
Privacy Act Notice
The authority for collecting this information is the
Immigration Reform and Control Act of 1986, Pub. L. 99-603
(8 USC 1324a).
This information is for employers to verify the eligibility of
individuals for employment to preclude the unlawful hiring, or
recruiting or referring for a fee, of aliens who are not
authorized to work in the United States.
This information will be used by employers as a record of
their basis for determining eligibility of an employee to work
in the United States. The form will be kept by the employer
and made available for inspection by officials of U.S.
Immigration and Customs Enforcement, Department of Labor
and Office of Special Counsel for Immigration Related Unfair
Employment Practices.
EMPLOYERS MUST RETAIN COMPLETED FORM I-9
Form I-9 (Rev. 06/05/07) N Page 2
PLEASE DO NOT MAIL COMPLETED FORM I-9 TO ICE OR USCIS
OMB No. 1615-0047; Expires 06/30/09
Form I-9, Employment
Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Please read instructions carefully before completing this form. The instructions must be available during completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible individuals. Employers CANNOT
specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a
future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begins.
Print Name:
Last
First
Address (Street Name and Number)
City
State
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.
Middle Initial
Maiden Name
Apt. #
Date of Birth (month/day/year)
Zip Code
Social Security #
I attest, under penalty of perjury, that I am (check one of the following):
A citizen or national of the United States
A lawful permanent resident (Alien #) A
An alien authorized to work until
(Alien # or Admission #)
Employee's Signature
Date (month/day/year)
Preparer and/or Translator Certification. (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under
penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Preparer's/Translator's Signature
Print Name
Address (Street Name and Number, City, State, Zip Code)
Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A OR
examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and
expiration date, if any, of the document(s).
List A
OR
List B
AND
List C
Document title:
Issuing authority:
Document #:
Expiration Date (if any):
Document #:
CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that
the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
and that to the best of my knowledge the employee is eligible to work in the United States. (State
(month/day/year)
employment agencies may omit the date the employee began employment.)
Signature of Employer or Authorized Representative
Print Name
Business or Organization Name and Address (Street Name and Number, City, State, Zip Code)
Title
Section 3. Updating and Reverification. To be completed and signed by employer.
A. New Name (if applicable)
B. Date of Rehire (month/day/year) (if applicable)
C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment eligibility.
Document Title:
Document #:
l attest, under penalty of perjury, that to the best of my knowledge, this employee is eligible to work in the United States, and if the employee presented
document(s), the document(s) l have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative
Form I-9 (Rev. 06/05/07) N
LISTS OF ACCEPTABLE DOCUMENTS
LIST A
LIST B
Documents that Establish Both
Identity and Employment
Eligibility
OR
LIST C
Documents that Establish
Employment Eligibility
Documents that Establish
Identity
AND
1. U.S. Passport (unexpired or expired)
1. Driver's license or ID card issued by
a state or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height,
eye color and address
1. U.S. Social Security card issued by
the Social Security Administration
(other than a card stating it is not
valid for employment)
2. Permanent Resident Card or Alien
Registration Receipt Card (Form
I-551)
2. ID card issued by federal, state or
local government agencies or
entities, provided it contains a
photograph or information such as
name, date of birth, gender, height,
eye color and address
2. Certification of Birth Abroad
issued by the Department of State
(Form FS-545 or Form DS-1350)
3. An unexpired foreign passport with a
temporary I-551 stamp
3. School ID card with a photograph
3. Original or certified copy of a birth
certificate issued by a state,
county, municipal authority or
outlying possession of the United
States bearing an official seal
4. An unexpired Employment
Authorization Document that contains
a photograph
(Form I-766, I-688, I-688A, I-688B)
4. Voter's registration card
4. Native American tribal document
5. U.S. Military card or draft record
5. U.S. Citizen ID Card (Form I-197)
5. An unexpired foreign passport with
an unexpired Arrival-Departure
Record, Form I-94, bearing the same
name as the passport and containing
an endorsement of the alien's
nonimmigrant status, if that status
authorizes the alien to work for the
employer
6. Military dependent's ID card
6. ID Card for use of Resident
Citizen in the United States (Form
I-179)
7. U.S. Coast Guard Merchant Mariner
Card
8. Native American tribal document
9. Driver's license issued by a Canadian
government authority
7. Unexpired employment
authorization document issued by
DHS (other than those listed under
List A)
For persons under age 18 who
are unable to present a
document listed above:
10. School record or report card
11. Clinic, doctor or hospital record
12. Day-care or nursery school record
Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)
Form I-9 (Rev. 06/05/07) N Page 2
WAREHOUSE SUPERVISOR
250
Position Summary
Warehouse Supervisors are responsible for managing the daily operations of the warehouse. This includes direct supervision
of warehouse personnel and first-line responsibility for inventory.
Responsibilities (include, but are not limited to the following)
Ensure the security and accuracy of physical inventory
Hiring, training, and supervision of warehouse personnel
Establish and maintain employee work schedules
Verify work orders daily
Ensure that all work for the following day has been cut and staged by the end of the current day
Process “dead-outs”
Process return-to-stock items
Organize and maintain warehouse filing system
Perform facility inspection s for safety violations and cleanliness daily
Assist with various installation problems that develop
Assist with cutting carpet and vinyl
Receive material shipments and process the necessary paperwork
Process bin transfers and stock adjustments
Ensure compliance with all OSHA standards regarding forklift operation and warehouse working conditions
Conduct forklift training and complete OSHA certifications for all warehouse employees
Supervise monthly pad count and ensure acceptable pad gain
Initiate and supervise regular inventory cycle counts
Assist with quarterly physical inventory counts
Hold and document quarterly safety meetings
Assist with various tasks as requested by supervisor
Important Goals and Deadlines
Before leaving everyday, all jobs for the following day must be cut and staged
Bin transfers, stock adjustments, and return-to-stock paperwork processed daily
Monthly pad counts should be completed within three days following the end of the month
Quarterly physical inventory counts should be completed within two weeks before or after the end of the quarter
Ensure that pad cut bins are restocked on a daily basis
Complete at least one TTN course every month
Qualifications
1+ years of warehouse experience with proven track record of inventory control
Good organizational and problem solving skills
Forklift experience preferred, OSHA certification required
Ability to work in a fast-paced environment
Ability to follow procedures and maintain safe working environment
Basic understanding of inventory transactions and reports
Basic computer skills
High school diploma
_______________________________________
Employee
____________________________________
Supervisor
___________________
Date
____________________
Date
Revised 03/17/03 - Page 1 of 1
WAGE DEDUCTION AUTHORIZATION AGREEMENT
I, _________________________ understand and agree that my employer, Redi Carpet
(Employee Name)
may deduct money from my pay for reasons that fall into the following categories:
1. My share of the premiums for Redi Carpet’s group medical/dental plan;
2. Any contributions I may make into a retirement or pension plan sponsored, controlled or
managed by Redi Carpet;
3. Installment payments on loans or wage advances given to me by Redi Carpet, and if
there is a balance remaining when I leave Redi Carpet, the balance of such loans or
advances;
4. If I receive an overpayment of wages for any reason, repayment of such overpayments
to Redi Carpet;
5. The cost to Redi Carpet of personal long distance calls I may make on Redi Carpet’s
phones or on Redi Carpet’s accounts, of personal faxes sent by me using Redi Carpet’s
equipment or Redi Carpet’s accounts, or of non work-related access to the Internet or
other computer networks by me using Redi Carpet’s equipment or accounts;
6. The cost of repairing or replacing any Redi Carpet supplies, material, equipment, money
or other property that I may damage (other than normal wear and tear), lose, fail to
return or take without appropriate authorization from Redi Carpet during my employment;
7. If I take paid vacation or sick leave in advance of the date I would normally be entitled to
it and I separate from Redi Carpet before accruing time to cover such advance leave, the
value of such leave taken in advance that is not so covered;
8. If I disregard the credit policies of Redi Carpet and extend credit to any customer without
approval of the Credit Department, I can then be held fully responsible for the collection
of the receivable amount. It is my understanding that Sales Service cannot accept a non
COD order without the Credit Department’s approval;
9. It is my responsibility to collect any money on matters that pertain to my sales. If it is
proven that I have disregarded the credit policies, extended credit without authorization
and Redi Carpet or myself cannot collect the amount due, I agree that such amount
owed can be deducted from my wages.
I have also received the following items. I understand that if I do not return these items, the cost
of the items may be deducted from my last paycheck.
Policy Manual
Building Keys
Employee Signature
Date
____________
Redi Carpet Representative
Date
WAIVER OF COMPANY RESPONSIBILITY FOR
COLLISION DAMAGES
I understand that a requirement of employment is that, if driving on company
business, I maintain collision insurance on my personal automobile. If I should
elect now, or in the future, not to carry such insurance, I waive the company of
any responsibility for damages to my automobile.
Employee Signature
Employee’s Printed Name
Date
Witnessed by
Witness’ Printed Name
Date
EMPLOYEE ACKNOWLEDGMENT FORM
The Employee Handbook describes important information about Redi
Carpet, and I understand that I should consult my Department Head
regarding any questions not answered in the Handbook. I have
entered into my employment relationship with Redi Carpet voluntarily
and acknowledge that there is no specified length of employment.
Accordingly, either I or Redi Carpet can terminate the relationship at
will, with or without cause, at any time, so long as there is no violation
of applicable Federal or State law.
Since the information, policies and benefits described here are
necessarily subject to change, I acknowledge that revisions to the
Handbook may occur, except to Redi Carpet’s policy of EmploymentAt-Will. All such changes will be communicated through official
notices, and I understand that revised information may supersede,
modify or eliminate existing policies. Only the Chief Executive Officer
or President of Redi Carpet has the ability to adopt any revisions to
the policies in this Handbook.
Furthermore, I acknowledge that this Handbook is neither a contract
of employment nor a legal document. I have received a user name
and password to access the Employee Handbook online at
www.redicarpet.com and I understand that I can access the branch
Employee Handbook kept by the Office Manager. I understand it is
my responsibility to read and comply with the policies contained in
this Handbook and any revisions made to it.
Employee’s Signature
Employee’s Name, printed
February 19, 2007
Date
12802 Capricorn
Stafford, TX 77477
Phone: 281-240-2500
Fax: 281-240-7334
First Name
Social Security #
Last Name
Home Phone #
Home Address
City
Cell Phone #
(Mandatory for Sales)
State
Zip
Birth Date
County
Marital Status
(not countr y,U SA)
(please circle one)
Ethnic Orgin
(please circle one)
Asian, African American
Native American
Hispanic, White
First Contact
Gender
Smoker
Disability
Name
Relation
Relation
Home Phone
Home Phone
Business Phone
Business Phone
Married
{ Male
{ Female
{ Yes
{ No
{ Yes
{ No
Second Contact
Name
Master Employee Data Sheet April 5, 2006
Single
Direct Deposit Agreement
AUTHORIZATION AGREEMENT FOR AUTOMATIC DIRECT DEPOSIT (ACH CREDITS)
I hereby authorize Redi Carpet Sales, herein after called COMPANY, to initiate credit entries
and to initiate, if necessary debit entries and adjustments of any credit entries in error to my
( )Checking ( )Savings account indicated below at the depository named below,
herein after called DEPOSITORY, to credit and or debit to the same account.
DEPOSITORY
BANK NAME
BRANCH
CITY
STATE
ROUTING #
(first 9 digits)
ACCT#
(next set of digits)
This authorization is to remain in full force and effect until Redi Carpet has received written
notification from me of its termination in such time and in such manner as to afford Redi
Carpet and DEPOSITORY a reasonable opportunity to act on it.
YOUR NAME
SSN#
REDI CARPET BRANCH ______________
DATE
SIGNATURE
NOTE: All written credit authorizations should provide that the receiver may revoke the
authorization only by notifying the originator in the manner specified in the authorization.
Return SIGNED agreements to Imelda McKee at the Corporate Office. Thank you.
Attach copy of voided check
for banking verification.
Deposit slip is not acceptable.
C:\Users\bkoehn\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\OREC0E1V\Direct Deposit Agreement.doc
NEW EMPLOYEE SAFETY ORIENTATION CHECKLIST
F39
This is a brief, itemized summary of topics to cover with each new or transferred employee prior to having that employee
start work:
Covered
• BRANCH TOUR
(Discuss specific hazards, locations of problems, and job safety controls
_
______
•
LOCATION/USE OF FIRST AID and RESPONDERS/FACILITIES
_
______
•
COMPANY SAFETY POLICY and THEIR ROLE IN THE PROGRAM
_
______
•
USE, CARE, AND MAINTENANCE OF PERSONAL PROTECTIVE EQUIPMENT
(Protective shoes, glasses/prescription eyewear, ear protection, respirators, gloves, etc.)
_
______
SPECIFIC SAFETY EXPECTATIONS IN YOUR DEPARTMENT
(Explain the specific precautions and the reasons for these rules)
_
______
•
MATERIAL HANDLING /LIFTING TECHNIQUES AND BODY MECHANICS
_
______
•
USE OF MACHINE SAFEGUARDING, HAND TOOLS, AND MECHANICAL
MATERIAL HANDLING EQUIPMENT
_
______
•
DEFENSIVE DRIVING, COMPANY EXPECTATIONS, AND RESPONSIBILITIES
_
______
•
FIRE SAFETY PRECAUTIONS
(Designated smoking areas, control of flammable/combustible materials, etc.)
_
______
•
LOCATION AND USE OF FIRE EXTINGUISHERS AND EVACUATION PLANNING
_
______
•
FIRE OR OTHER EMERGENCY PREPAREDNESS
(Natural disaster, medical or environmental spills, bomb threats, violence, etc.)
_
______
•
WHAT TO DO IF YOU SPOT A HAZARD OR UNSAFE WORK PRACTICE
_
______
•
WHEN AN INCIDENT OCCURS (Injury or property damage)
(Reports, investigations, obtaining medical treatment, returning to work, follow-up, etc.)
•
I acknowledge that information on the above subjects was furnished to me during my orientation.
EMPLOYEE’S SIGNATURE
Branch
I have instructed the above-named employee in the fundamentals of safety practices.
SUPERVISOR’S SIGNATURE
Branch
Revised 03/10/04 - Page 1 of 1
Consent to Request Consumer Report & Investigative Consumer Report Information
Applicant's First Name or Initial
Last Name
I understand that RediCarpet, Inc. (‘COMPANY’) will use Sterling InfoSystems Inc., 249 West 17th Street, New York, NY
10011, (877) 424-2457 to obtain a consumer report and/or investigative consumer report (“Report”) as part of the hiring process. I
also understand that if hired, to the extent permitted by law, COMPANY may obtain further Reports from STERLING so as to update,
renew or extend my employment.
I understand Sterling InfoSystems Inc.’s (“STERLING”) investigation may include obtaining information regarding my credit
background, bankruptcies, lawsuits, judgments, paid tax liens, unlawful detainer actions, failure to pay spousal or child support,
accounts placed for collection, character, general reputation, personal characteristics and standard of living, driving record and criminal
record, subject to any limitations imposed by applicable federal and state law.
I understand such information may be obtained
through direct or indirect contact with former employers, schools, financial institutions, landlords and public agencies or other persons
who may have such knowledge. If an investigative consumer report is being requested, I understand such information may be
obtained through any means, including but not limited to personal interviews with my acquaintances and/or associates or with others
whom I am acquainted.
The nature and scope of the investigation sought is indicated by the selected services below: (Employer Use Only)
Criminal Background Check
Education Verification
Sex Offender Search
SSN Trace
Employment Verification
OFAC/Terrorist Watch List
Motor Vehicle Report
Personal Reference
Fraud & Abuse Control Info System (FACIS®)
Consumer Credit Report
Professional License/Certification
Office of Inspector General Sanctions (OIG)
Other Please List:
I acknowledge receipt of the attached summary of my rights under the Fair Credit Reporting Act and, as required by law, any related
state summary of rights (collectively “Summaries of Rights”).
This consent will not affect my ability to question or dispute the accuracy of any information contained in a Report. I understand if
COMPANY makes a conditional decision to disqualify me based all or in part on my Report, I will be provided with a copy of the Report
and another copy of the Summaries of Rights, and if I disagree with the accuracy of the purported disqualifying information in the
Report, I must notify COMPANY within five business days of my receipt of the Report that I am challenging the accuracy of such
information with STERLING.
I hereby consent to this investigation and authorize COMPANY to procure a Report on my background.
In order to verify my identity for the purposes of Report preparation, I am voluntarily releasing my date of birth, social security
number and the other information and fully understand that all employment decisions are based on legitimate non-discriminatory
reasons.
The name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries
regarding the investigative consumer report is:
Sterling Infosystems, Inc. | 249 W 17th St. 6th Floor, New York, NY 10011 | 877-424-2457 | or | 5750 West Oaks Boulevard, Ste. 100
Rocklin, CA 95765 | 800-943-2589 |
 California, Maine, Massachusetts, Minnesota, New Jersey & Oklahoma Applicants Only: I have the right to request a copy
of any Report obtained by COMPANY from STERLING by checking the box. (Check only if you wish to receive a copy)
 California, Connecticut, Maryland, Oregon, Vermont and Washington State Applicants Only (AS APPLICABLE): I further
understand that COMPANY will not obtain information about my credit history, credit worthiness, credit standing, or credit capacity
unless: (i) the information is required by law; (ii) I am seeking employment with a financial institution (California, Connecticut and
Vermont only – in California the financial institution must be subject to Sections 6801-6809 of the U.S. Code and in Vermont it must
be a financial institution as defined in 8 V.S.A.§ 11101(32) or a credit union as defined in 8 V.S.A. § 30101(5)); (iii) I am seeking
employment with a financial institution that accepts deposits that are insured by a federal agency, or an affiliate or subsidiary of the
financial institution or a credit union share guaranty corporation that is approved by the Maryland Commissioner of Financial
www.sterlinginfosystems.com
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249 West 17th Street, 6 Floor, New York, NY 10011  Telephone 212-812-1020  877-424-2457  Facsimile 646-536-5239
7/2012
Regulation or an entity or an affiliate of the entity that is registered as an investment advisor with the United States Securities and
Exchange Commission (Maryland only); (iv) I am seeking employment in a position which involves access to confidential financial
information (Vermont only); (v) I am seeking employment in a position which requires a financial fiduciary responsibility to the
employer or a client of the employer, including the authority to issue payments, collect debts, transfer money, or enter into
contracts (Vermont only); (vi) COMPANY can demonstrate that the information is a valid and reliable predictor of employee
performance in the specific position being sought or held; (vii) I am seeking employment in a position that involves access to an
employer’s payroll information (Vermont only); (viii) the information is substantially job related, and the bona fide reasons
for using the information are disclosed to me in writing, (complete the question below) (Connecticut, Maryland, Oregon
and Washington only);(ix) I am seeking employment as a covered law enforcement officer, emergency medical personnel, firefighter
police officer, peace officer or other law enforcement position (California, Oregon and Vermont only - in Oregon the police or peace
officer position must be sought with a federally insured bank or credit union and in Vermont the law enforcement officer position
must be as defined in 20 V.S.A. § 2358, the emergency medical personnel must be as defined in 24 V.S.A. § 2651(6), and the
firefighter position must be as defined in 20 V.S.A. § 3151(3)); (x) the COMPANY reasonably believes I have engaged in specific
activity that constitutes a violation of law related to my employment (Connecticut only); (xi) I am seeking a position with the state
Department of Justice (California only); (xii) I am seeking a position as an exempt managerial employee (California only); and/or
(xiii)) I am seeking employment in a position (other than regular solicitation of credit card applications at a retail establishment) that
involves regular access to all of the following personal information of any one person: bank or credit card account information, social
security number, and date of birth,, I am seeking employment in a position that requires me to be a named signatory on the
employer’s bank or credit card or otherwise authorized to enter into financial contracts on behalf of the employer, I am seeking
employment in a position that involves access to confidential or proprietary information of the Company or regular access to $10,000
or more in cash (California only).
Bona fide reasons why COMPANY considers credit information substantially job related (complete if this is the sole
basis for obtaining credit information) or in California and Vermont the COMPANY’S basis for the credit check.
___________________________________________________________________________________________________________
NY Applicants Only: I also acknowledge that I have received the attached copy of Article 23A of New York’s Correction Law. I further
understand that I may request a copy of any investigative consumer report by contacting STERLING. I further understand that I will be
advised if any further checks are requested and provided the name and address of the consumer reporting agency.
California Applicants and Residents: If I am applying for employment in California or reside in California, I understand I have the
right to visually inspect the files concerning me maintained by an investigative consumer reporting agency during normal business
hours and upon reasonable notice. The inspection can be done in person, and, if I appear in person and furnish proper identification; I
am entitled to a copy of the file for a fee not to exceed the actual costs of duplication. I am entitled to be accompanied by one person
of my choosing, who shall furnish reasonable identification. The inspection can also be done via certified mail if I make a written
request, with proper identification, for copies to be sent to a specified addressee. I can also request a summary of the information to
be provided by telephone if I make a written request, with proper identification for telephone disclosure, and the toll charge, if any, for
the telephone call is prepaid by or directly charged to me. I further understand that the investigative consumer reporting agency shall
provide trained personnel to explain to me any of the information furnished to me; I shall receive from the investigative consumer
reporting agency a written explanation of any coded information contained in files maintained on me. “Proper identification” as used
in this paragraph means information generally deemed sufficient to identify a person, including documents such as a valid driver’s
license, social security account number, military identification card and credit cards. I understand that I can access the following
website http://sterlinginfosystems.com/privacy to view STERLING’S privacy practices, including information with respect to
STERLING’S preparation and processing of investigative consumer reports and guidance as to whether my personal information will be
sent outside the United States or its territories.
_______________________________________________________________________________
Signature:
_______________
Today’s Date:
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07/2012
R
S
I
R
E
D
I
C
A
R
P
E
T
For Office Use Only – Group ID (optional)
For Office Use Only – User ID (optional)
For Office Use Only – Location / Store # (optional)
First Name
Middle Name or Initial
Last Name
Date of Birth (MMDDYYYY)
Other Names Known By
Male
Primary Telephone Number (no dashes)
Current Address
City
Female
Apt #
State
Previous Address
Zip Code
Apt #
City
State
Driver’s License Number (no dashes)
License State
#yrs at this address
#yrs at this address
Zip Code
Email Address
Signature
Today’s Date (MMDDYYYY)
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07/2012
Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response
Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of
consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty
agencies (such as agencies that sell information about check writing histories, medical records, and rental history records).
Here is a summary of your major rights under the FCRA. For more information, including information about additional
rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission,
600 Pennsylvania Ave. N.W., Washington, D.C. 20580.

You must be told if information in your file has been used against you. Anyone who uses a credit report or
another type of consumer report to deny your application for credit, insurance, or employment – or to take another
adverse action against you – must tell you, and must give you the name, address, and phone number of the agency
that provided the information.

You have the right to know what is in your file. You may request and obtain all the information about you in the
files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification,
which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a
free file disclosure if:
a person has taken adverse action against you because of information in your credit report;
you are the victim of identify theft and place a fraud alert in your file;
your file contains inaccurate information as a result of fraud;
you are on public assistance;
you are unemployed but expect to apply for employment within 60 days.





In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from
each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for
additional information.

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness
based on information from credit bureaus. You may request a credit score from consumer reporting agencies that
create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some
mortgage transactions, you will receive credit score information for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that
is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless
your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information.
Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However,
a consumer reporting agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer
reporting agency may not report negative information that is more than seven years old, or bankruptcies that are
more than 10 years old.

Access to your file is limited. A consumer reporting agency may provide information about you only to people
with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business.
The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not
give out information about you to your employer, or a potential employer, without your written consent given to the
employer. Written consent generally is not required in the trucking industry. For more information, go to
www.ftc.gov/credit.

You may limit “prescreened” offers of credit and insurance you get based on information in your credit
report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call
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07/2012
if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the
nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer
reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in
state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.ftc.gov/credit.
States may enforce the FCRA, and many states have their own consumer reporting laws. In
some cases, you may have more rights under state law. For more information, contact your
state or local consumer protection agency or your state Attorney General. Federal enforcers
are:
TYPE OF BUSINESS:
Consumer reporting agencies, creditors and others not listed
below
National banks, federal branches/agencies of foreign banks
(word
"National" or initials "N.A." appear in or after bank's name)
Federal Reserve System member banks (except national
banks,
and federal branches/agencies of foreign banks)
Savings associations and federally chartered savings banks
(word
"Federal" or initials "F.S.B." appear in federal institution's
name)
Federal credit unions (words "Federal Credit Union" appear
in
institution's name)
State-chartered banks that are not members of the Federal
Reserve
System
Air, surface, or rail common carriers regulated by former
Civil
Aeronautics Board or Interstate Commerce Commission
Activities subject to the Packers and Stockyards Act, 1921
CONTACT:
Federal Trade Commission: Consumer Response Center –
FCRA Washington, DC 20580
1-877-382-4357
Office of the Comptroller of the Currency
Compliance Management, Mail Stop 6-6 Washington, DC
20219
800-613-6743
Federal Reserve Consumer Help (FRCH)
P O Box 1200
Minneapolis, MN 55480
Telephone: 888-851-1920
Website Address: www.federalreserveconsumerhelp.gov
Email Address: ConsumerHelp@FederalReserve.gov
Office of Thrift Supervision
Consumer Complaints
Washington, DC 20552
800-842-6929
National Credit Union Administration
1775 Duke Street
Alexandria, VA 22314
703-519-4600
Federal Deposit Insurance Corporation
Consumer Response Center, 2345 Grand Avenue, Suite
100
Kansas City, Missouri 64108-2638
1-877-275-3342
Department of Transportation , Office of Financial
Management
Washington, DC 20590
202-366-1306
Department of Agriculture
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