Hire Package Enrollment Card Information Email Initials Full Name Address APT # City State Zip Code Phone Social Security Drivers License Date of Birth Date of Employment I certify that this informaton is true and correct to the best of my knowledge. I understand that the information above may be subject to verification. Name/Relationship/Phone Number of person to contact in case of emergency Name Relationship Phone Employee Data Social Security Number First Name Last Name Home Address Do not use Employer Adderess, Do not leave blank. Date of Hire Employer Data Federal EIN Name Address Additional Information Store or Outlet Number Gender Male Female State of Hire Date of birth Earned Income Tax Credit Available?: -- Yes No if unknown, leave blank. Employee Left Your Employment?: -- Yes No Has this employee left your employment before you find this report? Does your company offer Medical insurance? -- Yes No Corporate or Payroll Address U.S. Department of Labor Information Control No For Agency use only. Date Received For Agency use only. Employer Name Employer Address Telephone Employer Federal ID Number (EIN) Applicant Name Last, First, MI. Social Security Number Have you worked for this employer before? Yes No Last Date of Employment Employment Start Date Starting Wage Position Are you at least age 16, but under age 40? Yes No Date of Birth Are you a Veteran of the U.S. Armed Forces Yes No SNAP Benefits Yes No Are you a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (Food Stamps) for at least 3 months during 15 months before you were hired? Name of primary recipient City and State where benefits received Service Connected Disability? Yes No Are you a veteran entitled compensation for a service connected disability? Discharged or Released Yes No Were you discharged or released from active duty within a year before you were hired? Unemployed for a Combined Period? Yes No Were you unempoyed for a combined period of at least 6 months (whether or not conseoutive) during the year before you were hired? SNAP Benefits Yes No Are you a member of a family that received Supplemental Nutrition Assistance Program (SNAP) benefits (Food Stamps) for the 6 before you were hired? Food Stamps Yes No Received Food Stamps for at least 3 month period within the last 5 months But you are no longer receiving them? Name of primary recipient City and State where benefits received Referred to an Employer by a VRA Yes No Were you referred to an employer by a Vocational Rehabilitation Agency approved by a State? Referred to an Employer by a EN Yes No Were you referred to an employer by an Employment Network under the Ticket to Work Program? Referred to an Employer by a DVA Yes No Were you referred to an employer by the Department of Veterans Affairs? Received TANF assistance? Yes No Are you a member of a family that received TANF assistance for at least the last 18 months before you were hired? TANF for earliest 18 month period? Yes No Are you a member of a family that received TANF benefits for any 18 months beginning after August 5, 1997, and the earliest 18-month period beginning after August 5, 1997. ended within 2 years before you were hired? TANF eligible stop? Yes No Did your family stop being eligible for TANF assistance within 2 years before you were hired because a Federal or state law limited the maximum time those payments could be made? TANF 9 months assistance? Yes No Are you a memeber of a family that received TANF assistance for any 9 months during the 18-month oeriod before you were hired? Name of Primary Recipient City & State City and State where benefits were received. Felony Conviction Yes No Date of Conviction Date of Release Was This? Federal State conviction Live in Rural? Yes No Do you live in Rural Renewal County? SSI Benefits? Yes No Did you receive Supplemental Security Income (SSI) benefits for any month ending within 60 days before you were hired? Veteran Unemployed for 6 Months Yes No Are you a veteran unemployed for a combinerd period of at least 6 months (whether or not consecutive) during the year before you were hired? Veteran Unemployed for 4 Weeks Yes No Are you a veteran unemployed for a combinerd period of at least 4 weeks but less than 6 months (whether or not consecutive) during the year before you were hired? Sources used to document eligibility Employers/Consultants: List all dicumentation provided or forthcoming. SWAs: List all documentation used in determining target group eligibility and enter your initials and date when determination was made. Who Signed a form? Employer Consultant SWA Participating Agency Applicant Parent/Guardian (if applicant is a minor) Full Name Initials I certify that this informaton is true and correct to the best of my knowledge. I understand that the information above may be subject to verification. Receipt For Employee Handbook Full Name Initials Date Store Number I have received my copy of the Employee Handbook. I agree to read and keep my handbook for future reference and observe present and future company personnel policies and ules outlined in this handbook. I uderstand this handbook is a summary of the policies and rules which guide Pinnacle Sales in it's relationship with it's employees. It is not a contract of employement, and I do not construe it as such. I understand that employment is terminable at will of either the employee or the employer. The policies and procedures contained in this handbook are not conditions of employment. I understand that Pinnacle Sales may revise the policies and procedures in this handbook, in whole or in part, at any time, with or without notice. Drug Screening Full Name Initials Date All new employees have to take and pass a Drug Screening before elegible for employment. If you have passed your Drug Screening and hired by Pinnacle Sales Company you will be responsible for the charge of ($50.00) which is the amount of the Drug Screening. If you do not show up for work, leave employment or terminated within the 90 day probation period. Pinnacle Sales Company Grooming Policy Our Shaving policy states that you will be clean shaven prior to working. Your facial hair (beard, mustache, goatee) must not exceed 1/4 of an inch. You will shave around the beard, goatee, etc so that there is a clean line. Your manager will forfeit 10% of their bonus every time they allow you to break this policy. We are a Customer Service business, and will present ourselves appropriately. Earrings (on any part of your facial area) and gauges are not allowed to worn while on the timeclock. Your hair must be kept cut above the collar and washed regularly. Full Name Initials Date I understand and agree to abide by the rules set forth by Pinnacle Sales Company. If I do not follow them, I understand they have the right not to pay me for the hours I worked while violating these policies and can be terminated immediately for doing so. Computer Based Training Full Name Initials Date Jiffy Lube International requires all employees to complete each Computer Based Training module that encompass the positions and services that Jiffy Lube requires. While there is ample time to complete these modules between cars during the day at the store, employees have requested to have access to complete these at home. If the required modules are not completed by month's end, you will forfeit your employee/manager bonus for that month. If you choose to complete these off the clock at home, you understand that you will not be paid for those hours completing the required modules. I acknowledge that there is ample time to complete the required modules during my shift over the course of each day/month, and will not hold Pinnacle Sales Company liable for any time spent taking these off the clock or off store permisses. Sexual Harassment Sexual harassment in no laughing matter. It is not just a joke or just an innocent workplace fraternization. It is direct violation of Title VII of the Civil rights Act of 1964. The 1991 Civil Rights Act gave victims of sexual harassment the right to jury triaks as well as compensitory and ounitive damage awards.The EEOC has issued guidelines on sexual harassment. THe guidelines are not laws but carry a great deal of weight with how the courts view and anaylize sexual harassment. What is Sexual Harrassment? What is Quid Pro Quo Sexual Harrassment? What is "Hostile Environment" Sexual Harrassment? What Factors Determine Whether an Environment is Hostile? What is Unwelcome Sexual Conduct? How Will the EEOC Determine Whether Conduct is Unwelcome? Who Can Be A Victim of Sexual Harrassment? What is Sexual Harrassment? Sexual harassment is a form of sex discrimination which is a violation of Title VII of Civil Rights Act of 1964. The EEOC's guidelines defien two types if sexual harassment: "quid pro quo" and "hostile environment." What is Quid Pro Quo Sexual Harrassment? Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute "quid pro quo" sexual harassment when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an indicidual's employment, or (2) submission to rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual. What is "Hostile Environment" Sexual Harrassment? Unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature constitute "hostile environment" sexual harassment when such conduct gas the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile, or offensive working environment. What Factors Determine Whether an Environment is Hostile? The central inquiry is whether the conduct "unreasonably interfered with an individual's work performance" or created "an intimidating, hostile, or offensive working environment." The EEOC will look at the following factors to determine whether an environment is hostile: (1) whether the conduct was verbal or physical or both; (2) how frequently it was repeated; (3) whether the conduct was hostile or patently offensive; (4) whether the alleged harasser was a co-worker or supervisor; (5) whether others joined in perpetrating the harassment and whether he harassement was directed at more than one individual. No one factor controls. An assessment is made based upon the totality of the circumstances. What is Unwelcome Sexual Conduct? Sexual conduct becomes unlawful only when it is unwelcome. The challenged conduct must be unwelcome in the sense that the employee did not solicit or incite it, and in the sense that the employee regarded the conduct as undesirable or offensive. How Will the EEOC Determine Whether Conduct is Unwelcome? When confronted with conflicting evidence as to whether conduct was welcome, the EEOC will look at the record as a whole and at the totality of the circumstances, evaluating each situation on a case-by-case basis. The investigation should determine whether the victim's conduct was consistent, with his/her assertion that the sexual conduct was unwelcome. Who Can Be A Victim of Sexual Harassment? The victim may be a woman or a man. The victim does not have to be the opposite sex. The victim does not have to be the person harassed by could be anyone affected by the offensive conduct. Full Name Initials Date Sexual Harassment will not be tolerated in the workplace. We want all employees to feel safe and welcome in their enviorment while at work. Customer Privacy Full Name Initials Date Our customer's records (phone numbers, addresses, email addresses, etc.) are private and are not to be shared with anyone outside of work. I understand and will comply with this company policy.