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 [email protected] 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 by Manager and Employee 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 by Manager and Employee (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 Social Security Number 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: $_____________________________ Current Amount of Coverage: $_____________________________ Increase coverage by: $____________________________ Increase coverage by: $____________________________ Decrease 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: Current Amount of Coverage: $_____________________________ Current Amount of Coverage: $_____________________________ Increase coverage by: $____________________________ Increase coverage by: $____________________________ Decrease coverage by: $___________________________ Decrease coverage by: $___________________________ Total Amount of Coverage: $_____________________________ Total Amount of Coverage: $_______________________________ Dependent Child Supplemental Life: Dependent Child AD&D: Current Amount of Coverage: $_____________________________ Current Amount of Coverage: $_____________________________ Increase coverage by: $____________________________ Increase coverage by: $____________________________ Decrease coverage by: $___________________________ Decrease coverage by: $___________________________ Total Amount of Coverage: $_____________________________ Total Amount of Coverage: $_______________________________ 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 D:\NewHire\Employment Agreement Georgia .doc -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. D:\NewHire\Employment Agreement Georgia .doc -4- REDI-CARPET SALES OF GEORGIA, LLC. By: Name: Title: "EMPLOYEE" ______________________________________ Name D:\NewHire\Employment Agreement Georgia .doc -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 Date (month/day/year) 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 #: Expiration Date (if any): 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 Date (month/day/year) 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 #: Expiration Date (if any): 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 Date (month/day/year) 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 Page 1 of 5 th 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: www.sterlinginfosystems.com Page 2 of 5 th 249 West 17th Street, 6 Floor, New York, NY 10011 Telephone 212-812-1020 877-424-2457 Facsimile 646-536-5239 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 Social Security Number 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) www.sterlinginfosystems.com Page 3 of 5 th 249 West 17th Street, 6 Floor, New York, NY 10011 Telephone 212-812-1020 877-424-2457 Facsimile 646-536-5239 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 www.sterlinginfosystems.com Page 4 of 5 th 249 West 17th Street, 6 Floor, New York, NY 10011 Telephone 212-812-1020 877-424-2457 Facsimile 646-536-5239 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: [email protected] 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 www.sterlinginfosystems.com Page 5 of 5 th 249 West 17th Street, 6 Floor, New York, NY 10011 Telephone 212-812-1020 877-424-2457 Facsimile 646-536-5239 07/2012
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