Online Application

Personal Information

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Email

Home Phone

Cell Phone

DL #*

Position Applying For*

EPA Certified

Yes
No

Special Skills or Language

Education

List*

Name of School	Location	Dates Attended	Degree

A conviction will not automatically disqualify an applicant for a particular job. The type and seriousness of the crime, the frequency of the violation(s), your age at the time of conviction, the date of conviction, time elapsed since the conviction, completion of any sentence, along with your entire work and educational history, as well as employment references and recommendations, will be considered.

Have You Ever Been Arrested or Convicted of a Crime?*

Yes
No

If so please explain in the box below. This includes deferred adjudication.

Year / Charges

Conviction

If so, please explain

Employment History

(Starting with Most Recent)

Job # 1

Name of Company*

Name of Supervisor*

Position

Phone

Hourly Rate

Reason For Leaving*

Rehire-able

Yes
No

Start Date*

Leave Date*

Job # 2

Name of Company

Name of Supervisor

Position

Phone

Hourly Rate

Reason For Leaving

Start Date

Leave Date

Job # 3

Name of Company

Name of Supervisor

Position

Phone

Hourly Rate

Reason For Leaving

Start Date

Leave Date

Job # 4

Name of Company

Name of Supervisor

Position

Phone

Hourly Rate

Reason For Leaving

Start Date

Leave Date

Employment Agreement with Platinum Apartment Staffing

Please Initial each Numbered Paragraph

1) I understand that I could receive an employment evaluation on each job assignment*

2) I understand that I will not be permitted to be absent from temporary assignments to interview for other employment. I understand that I will arrange to be interviewed on my own time, before or after my regular work hours. I further understand that I may be permitted to schedule an interview during my lunch period if I have obtained the prior approval of PAS.*

3) The following actions are considered job abandonment and immediate Termination in the event that I (a) Fail a drug screen give either by PAS, or by a client of PAS for purposes of full time or temporary employment, (b) walk off of a job before the end of my shift or (c) fail to return to complete my temporary assignment without notifying and obtaining approval from PAS. I understand by these actions, that any monies owed to me will be reduced to minimum wage for that job assignment.*

4) I understand that I am responsible to CALL IN DAILY for availability to PAS. In the event that I fail to notify PAS daily, I will be considered to have left voluntarily without work-connected reason, and PAS may deny unemployment benefits.*

5) I understand that equipment or supplies that are supplied by the client are not for my personal use. If Assigned to a temporary position by PAS I understand that I will be required to work a total of 160 consecutive hours on a temporary basis at that property prior to conversion to a permanent position unless a placement fee is paid. If the client refuses to pay the placement fee and I accept the position, I understand that I will be required to pay the fee for the position I am filling.*

6) understand that my payroll won't be processed without an authorized signature from client(s) of PAS.*

7) I understand that PAS is not responsible for my timesheet collection. Without a timesheet we will be unable to process your payroll. PLPASE MAKE SURE YOUR TIMESHEET IS COLLECTED. Timesheets are due Monday, no later than 12:00 PM. If you are not working weekends, then you should fax your timesheet before you leave on Friday.*

8) I understand that i will receive my check on friday in the event I lose my check a stop payment will be issued and I will be responsible for any bank charges.*

9) I understand any assignments that I work on involving Incidents regarding theft of any kind, will result in immediate suspension of pay until the incident is resolved. I further understand that if proven, I will be responsible for the monetary replacement theft(s) items of any kind by way of payroll deductions or prosecution.*

Please check the following box to agree to terms.*

I Agree to terms

Signature*

Typing name will be considered electronic signature.

Date

Drug Abuse and Harassment Policy

I agree to the policy.

Platinum Apartment Staffing (PAS) has adopted the following Policy to apply to all of its full-time, part-time, and temporary Employees assigned to client companies as well as its corporate staff. This policy is adopted in order to help you fulfill your job-related responsibilities by understanding the company's position on any drug abuse.

For purposes of this policy, the term "drug" includes alcoholic beverages and prescription drugs, as well as illegal inhalants and illegal drugs. It specifically excludes prescription drugs when taken as directed by the employee's doctor.

Use of or being under the influence of a "drug" as herein defined is strictly prohibited during working hours, or within 3 hours prior to a scheduled work period. Being under the influence means being affected in any detectable manner or in possession of a "drug" while performing company assigned business or on client company property. Violation can lead to immediate job termination.

The company, at this time, does not sponsor a drug abuse training or education program not does it provide company funded or insurance funded rehabilitation programs. Any employee, however that wishes to seek guidance or counseling related to a drug abuse problem should contact PAS.

PAS does not at this time mandate drug testing with the exception of circumstances involving a workers compensation injury and claim. However, based on the unique contractual requirements of client companies, PAS reserves the right to universally do so at any time.

It is the policy of PAS to maintain a work place that is free of discrimination, including sexual harassment, and expect the full cooperation of all employees and clients in maintaining a professional work environment at all times. Any employee, who believes he or she has been subjected to discrimination or sexual harassment, or has witnessed such conduct, must immediately notify a PAS official. Abusive behavior, verbal or non-verbal shall not be tolerated and I agree to report such behavior to a PAS official immediately. It is recommended that complaints be submitted to PAS in writing to assist in the resolution of any complaint. It is our Policy to investigate complaints promptly and to keep complaints and the result of the investigation confidential to the fullest extent practicable except to extend necessary and fully to investigate and to act on results with an investigation. There will be no retaliation against anyone for reporting discrimination or harassment, or cooperating with such an investigation.

Signature*

Typing name will be considered electronic signature.

Date

Background Investiagation for Employment by Platinum Apartment Staffing (PAS)

Please check the following box to agree to the Background Investigation for Employment by Platinum Apartment Staffing (PAS)*

I agree

I hereby authorize and give my consent for PAS to conduct a background check, in connection with my potential employment with the company. I am herby advised the PAS background check will involve contacting some or all of the following organizations: federal and state law and drug enforcement agencies, department of motor vehicles, as well as other government agencies that retain criminal history records. I authorize PAS to contact these organizations to obtain information concerning me. I may submit a written request to PAS within 7 days to obtain detailed information about the scope of their investigation.

I hereby authorize the above listed organizations to release any criminal history records pertaining to me to PAS officials. I understand that a record of criminal conviction does not automatically disqualify an applicant from being employed by PAS.

PAS officers, agents and employees are hereby released of any and all liability as a result of the use or disclosure of any information received during the described background investigation. PAS may at its sole discretion, deny me employment based upon only information receive from my background investigation, which PAS considers unsatisfactory.

I have read and understand the terms of authorizing the background check described above. I further understand the information requested below will be used to conduct a background check.

Signature*

Typing Name will be considered electronic signature.

SSN#

DOB

DL #

Employment Verification

Employee Name

Employer:

Eligible for Re-hire

Dates of Employment

Additional Comments

W-4 Employee's Withholding Allowance Certificate

Complete For W-4 so that your employer can withhold the correct feder income tax from your pay. Give Form W-4 to yoru employer. Your Witholding is subject to review by the IRS

Name*

First Middle Last

Social Security Number

Home Address (number and street or rural route):*

Street Address Address Line 2 City State ZIP Code

Filing Status:*

Single or Married filing separately
Married filing jointly or qualifying widow(er)
Head of household (Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Note. If married, but legally separated, or spouse is a nonresident alien, check the "Single" box.

Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income eraned from all these jobs.

Do only one of the following.

(a)Use the estimator at www.irs.gov/w4app for most accurate withholding for this step (and steps 3-4); or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughtly accurate withholding; or
(c) If there are only two jobs total, you maycheck this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld.

TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete steps 3-4(b) on Form W-4 for only ONE of thse jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete steps 3-4(b) on the FOrm 2-r for the highest paying job)

Step 3 Claim Dependents

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,000*

Multiply the number of other depedents by $500*

Add the amounts above and enter the total here*

Step 4 (optional): Other Adjustments

(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of the other income here. This may included interest, dividends, and retirement income

(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here.

Extra withholding. Enter any additional tax you want withheld each pay period

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.)

Date

Form I-9 Employment Eligibility Verification

Section 1. Employee Information and Verification (To be completed and signed by employee at the time employment begins.)

Name

First Middle Last

Maiden Name

Date of Birth

Social Security #

Address

Street Address Address Line 2 City State ZIP Code

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):

A citizen of the United States
A noncitizen national of the United States (see instructions)
A lawful permanent resident
An alien authorized to work

Alien #

Or Admission #

Authorized to work until (expiration date)

Employee's Signature

Date

Preparer and / or Translator Certifcation

Preparer and/or Translator Certification (check one)

I did not use a preparer or translator
A preparer(s) and / or translator(s) assisted the employee in completing Section 1.

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

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.

Yes

Preparer's / Translator's Signature

Date

Preparer's / Translator's Name

First Last

Preparer's / Translator's Address

Street Address 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 below on LIST OF ACCEPTABLE DOCUMENTS, and record the title, number, and expiration date, if any, of the document(s).)

Are you using List A, or List B and List C?*

List A
List B and C

Please select if you are using 1 item from List A, or an Item from List B and an item from List C

Document Title

Issuing Authority

Document #

Expiration Date (If any)

Upload File

Max. file size: 8 MB.

Document Title

Issuing Authority

Document #

Expiration Date (If any)

Upload File

Max. file size: 8 MB.

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 (month/day/year) _________________ and that to the best of my knowledge the employee is authorized to work in the United States. (State employment agencies may omit the date the employee began employment.)

I agree

Date employee began employment

Employee or Authorized Representative Signature

Title

Date

Business or Organization Name

Employers Business or Organization Address

Street Address Address Line 2 City State ZIP Code

Reverification and Rehires

(To be completed and signed by employer or authorized representative.)

Name

First Middle Last

Date of Rehire

If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

Document Title	Document Number	Expiration Date (if any) (mm/dd/yyyy)

I attest under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

I agree

Signature of Employer or Authorized Representative

Date

Direct Deposit Information

Account type

Checking
Savings

Account Number

ABA Routing Number

Name

This field is for validation purposes and should be left unchanged.

PDF Application For Print