Employment Documentation - Prime Facility Services Group

Criminal Release Authorization and Staff Wages Agreement

Notification and Authorization to Release Information for Employment Purposes

The position for which I am being considered requires me to consent to a criminal background check as a condition of employment. I hereby authorize Prime Facility Services Group, Inc. to conduct the criminal background check. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist Prime Facility Services Group, Inc. in collecting this information. First Verify has been secured as a third party vendor (consumer reporting agency) to assist Prime Facility Services Group, Inc. in collecting and verifying information.

I am also aware that records of arrests on pending charges and/or convictions are not an absolute bar to employment. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner, which is safe for Prime Facility Services Group, Inc. employees, customers, and vendors.

By signing below, I am authorizing my background information to be released to Prime Facility Services Group, Inc.
Signature*

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Today's Date*

MonthDayYear

Staff Wages Agreement
I, hereby agree that I will be paid at a rate of $__/hour. The following procedures must be met in order to receive the aforementioned wages. Failure to following the procedures will result in wages paid at $7.25/hour. The first 3 days of training will be paid at $7.25/hour, after which your regular rate applies.
Employees Must:
1. Give a week's notice before quitting job
2. Not walk out mid shift
3. Not leave during training days
4. Not leave in the first week
5. Schedule time off/vacation a week in advance with Prime
6. Not be fired in the first week of work
7. The final check must be picked up in person at the main office located at 8303 Westglen Dr, Houston, Texas 77063
By signing below understand and agree to the staff wages agreement.
Signature*

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Today's Date*

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USCIS Form I-9
Employment Eligibility Verification

Department of Homeland Security U.S. Citizenship and Immigration Services

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. Click here for the instructions.

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.
Legal Names*

First NameMiddle InitialLast Name
Other Last Names Used (if any)
Address (Street Number and Name)*

Street Address

Apt. Number

City or TownState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
U.S. Social Security Number (SSN)*
Email*
Phone*
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.
I attest, under penalty of perjury, that I am (check one of the following boxes)*

U.S. CitizenU.S. Noncitizen NationalLawful Permanent ResidentAlien Authorized to Work
Alien Registration Number/USCIS Number*
Work authorization expiration date*

MonthDayYear
Select alien work authorization document*

Alien Registration Number/USCIS NumberForm I-94Foreign Passport Number
Form I-94 number*
Foreign Passport Number*
Country of Issuance*
Signature of Employee*

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Today's Date*

MonthDayYear
List of Acceptable Documents can be found in the link here.

W-9

Request for Taxpayer Identification Number and Certification
Check appropriate box for federal tax classification of the person whose name is entered. Check only one of the following boxes.

Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estate
Signature

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8850

Pre-Screening Notice and Certification Request for the Work Opportunity Credit
Check here if you received a conditional certification from the state workforce agency (SWA) or a participating local agency for the work opportunity credit.Check here if any of the following statements apply to you.• I am a member of a family that has received assistance from Temporary Assistance for Needy Families (TANF) for any 9months during the past 18 months.• I am a veteran and a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (foodstamps) for at least a 3-month period during the past 15 months.• I was referred here by a rehabilitation agency approved by the state, an employment network under the Ticket to Work program, or the Department of Veterans Affairs.• I am at least age 18 but not age 40 or older and I am a member of a family that:a.Received SNAP benefits (food stamps) for the past 6 months; orb. Received SNAP benefits (food stamps) for at least 3 of the past 5 months, but is no longer eligible to receive them.• During the past year, I was convicted of a felony or released from prison for a felony.• I received supplemental security income (SSI) benefits for any month ending during the past 60 days.• I am a veteran and I was unemployed for a period or periods totaling at least 4 weeks but less than 6 months during thepast yearCheck here if you are a veteran and you were unemployed for a period or periods totaling at least 6 months during the past yeaCheck here if you are a veteran entitled to compensation for a service-connected disability and you were discharged or released from active duty in the U.S. Armed Forces during the past year.Check here if you are a veteran entitled to compensation for a service-connected disability and you were unemployed for a period or periods totaling at least 6 months during the past year.Check here if you are a member of a family that:• Received TANF payments for at least the past 18 months; or• Received TANF payments for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997, ended during the past 2 years; or• Stopped being eligible for TANF payments during the past 2 years because federal or state law limited the maximum time those payments could be madeCheck here if you are in a period of unemployment that is at least 27 consecutive weeks and for all or part of that period you received unemployment compensation.
Name of the company
Signature

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Non-Compete Clause
Throughout the duration of this Agreement the Recipient shall not, in any manner, represent, provide services or engage in any aspects of business that would be deemed similar in nature to the business of Prime Facility Services Group, Inc. without its written consent, to any of its current clients and/or customers.

The Recipient warrants and guarantees that throughout the duration of this Agreement and for a period of 12 months following the culmination, completion or termination of its work cycle, that Recipient shall not directly or indirectly engage in any business that would be considered similar in nature to the business engaged in by Prime Facility Services Group, Inc., with any current clients and/or customers.
Signature*

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Prime Facility Services Group, Inc. Announces we are now offering Medical Insurance with United Healthcare for Employees in compliance with the Affordable Care

The Affordable Care Act will take effect February 1, 2015 Variable employees are eligible after one year of full time employment Benefits- unlimited, brief outline of coverage below
- Office Visits- $30 co-pay in network doctors $60 co-pay to see specialist
- Deductible- $3,000 per person/$6,000 per family
- Drugs- $10 co-pay for generic/$35 co-pay for approved name brand drugs
- Name brand drugs and $50 co-pay for non-approved name brand drugs
- Out of pocked limit $6,000 per person annually and $12,000 per family annually
Weekly Cost: $58
Please indicate below if you will accept or reject the coverage:*

AcceptReject
Signature*

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Today's Date*

MonthDayYear

Should be Empty:

	YES	NO
Asthma
Diabetes
Allergies
Headaches
Back Injury
Bleeding Disorders
Fracture
Hepatitis A,B,C
Hernia
High Blood Pressure
Hypoglycemia
Pacemaker
Pregnancy
Smoking
Any Serious Problems, Surgery
Drug- Alcohol Abuse
Hypertension

Employment Onboarding

Pre- Employment Physical Form

W-9

8850

Non-Compete Clause