CANDIDATE APPLICATION 2019

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a right fit for your employment needs. Por favor tome un minuto y conteste las siguiente preguntas esto nos ayudara para poder mejor ayudarle en su busca
de trabajo.

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Employment Application Form

General Information

Education Information

For Clerical Applicants Only:

Employment History

List all employers, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of complet-
ing the required information.

Next Most Recent Employer

Next Most Recent Employer

Next Most Recent Employer

Other Information

Certification and Authorization

The above information is true and correct.
 
I authorize the Company to inquire into my education, past employment history, and references as needed to
research my qualifications for this position.
 
If employed, I will be required to provide original documents which verify my identity and right to work in the
United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be
used for the completion of Form I-9.
 
I hereby acknowledge that I have read and agree to the above statements.

Company: Personnel Staffing Group, LLC. DBA KBS Staffing

Client ID:

Client Company Address:
480 W. Alluvial Avenue
Fresno, CA 93650
Client Company Phone:
559-436-6800


KBS Staffing
480 W. Alluvial Avenue
Fresno, CA. 93650
Phone number: 559-436-6800

Welcome to Personnel Staffing Group, LLC. DBA KBS Staffing (here in after “KBS”).The company for which you perform
services uses KBS to issue your paychecks, process your year-end W-2s, and to offer a variety of employee benefits for your
consideration. Under This agreement, you will be considered an employee of KBS. All information contained in this employment
agreement is important to your employment with KBS. All blanks must be completed and you must sign the agreement, including
the I-9 and W-4. A copy of your Social Security card is requested for employment tax purposes.

Check One of The Following:

At-Will Employment.

I, the undersigned employee, in consideration of my hiring by KBS as an at-will staffed employee of KBS, acknowledge and
agree to the following: I have been hired as an at-will employee of KBS which is an employee staffing company and there is no
contract of employment which exists between me and the client to which I have been assigned, nor between KBS and me. I
understand and agree that either KBS or I can terminate our employment relationship at any time, as I am an at-will employee. I
also agree that I may be assigned to an affiliated KBS company and employed by such company at any time at the sole and
complete discretion of KBS and without my consent or agreement. I also agree that while I am a staffed employee of KBS, if KBS
does not receive payment from client for services which I perform as a staffed employee, KBS will still pay me the applicable
minimum wage (or the legally required minimum salary or overtime pay) for any such pay period, and I agree to this method of
compensation. I understand that the client to which I am assigned at all times remains obligated to pay me my regular hourly rate
of pay if I am a non-exempt employee and to pay me my full salary if I am an exempt employee even if KBS is not paid by the
client to which I am assigned. I have been informed and I agree that if my assignment with any KBS client to which I am assigned
ends for any reason, I must report back to KBS within seventy-two (72) hours for possible reassignment and that unemployment
benefits may be denied me if I fail to do so. In recognition of the fact that any work injuries which might be sustained by me are
covered by state workers' compensation statutes, and to avoid the circumvention of such statutes which might result from suits
against the customers or clients of KBS or against KBS based on the same injury or injuries, and to the extent permitted by law, I
hereby waive and forever release any rights I might have to make claims or bring suit against any client or customer of KBS or
against KBS for damages based upon injuries which are covered under such workers' compensation statutes.

Client Company Paid Leave Policies and Other Benefits.

In the case that Client Company maintains policies providing paid leave benefits such as vacation, sick leave, PTO, or severance
pay, Client Company is solely responsible for paying any accrued benefits under such policies during employment and at the time
of termination. KBS does not provide, and has no policy providing, vacation or other paid leave benefits. To the extent paid leave
benefits are paid through KBS’s payroll to Employee, it is solely as a payroll service on behalf of Client Company. Similarly, to the
extent Client Company provides other benefits pursuant to policies to which KBS is not a party, such as stock options, bonuses,
profit sharing, retirement benefits, and so forth, Client Company is solely responsible for providing the benefits prescribed by
those policies.

Paid Sick Leave

Unless exempt, the employee identified on this notice is entitled to minimum requirements for paid sick leave under state law
which provides that an employee:

  1. May accrue paid sick leave and may request and use up to 3 days or 24 hours of accrued paid sick leave per year;
  2. May not be terminated or retaliated against for using or requesting the use of accrued paid sick leave; and
  3. Has the right to file a complaint against an employer who retaliates or discriminates against an employee for
  • Requesting or using accrued sick days;
  • Attempting to exercise the right to use accrued paid sick days;
  • Filing a complaint or alleging a violation of Article 1.5 section 245 et seq. of the California Labor Code;
  • Cooperating in an investigation or prosecution of an alleged violation of this Article or opposing any policy or practice or
    act that is prohibited by Article 1.5 section 245 et seq. of the California Labor Code.
    The following applies to the employee identified on this notice: (Check on box)
  1. Accrues paid sick leave only pursuant to the minimum requirements stated in Labor Code §245 et seq. with no other
    employer policy providing additional or different terms for accrual and use of paid sick leave.
  2. Accrues paid sick leave pursuant to the employer’s policy which satisfies or exceeds the accrual, carryover, and use
    requirements of Labor Code §246.
  3. Employer provides no less than 24 hours (or 3 days) of paid sick leave at the beginning of each 12-month period.
  4. The employee is exempt from paid sick leave protection by Labor Code §245.5 (State exemption and specific subsection
    for exemption):

KBS Staffing
480 W. Alluvial Avenue
Fresno, CA. 93650
Phone number: 559-436-6800

Assignment.

If Client Company files any form of bankruptcy, Employee will and hereby transfers to KBS all of his/her rights as a employee for
the purposes of payment of wages and applicable payroll taxes. For this right, KBS will compensate Employee an additional five
percent (5%) premium, on those amounts KBS receives from client as a result of the assignment of Employee’s rights.

Policies and Benefits.

Employee agrees to abide by the policies of KBS, including but not limited to policies contained in any applicable Employee
Handbook. Employee understands that eligibility and coverage for KBS benefits is controlled by the terms and conditions of the
applicable Plan Documents.

Medical Authorization.

I hereby authorize the release of any and all medical, hospital, vocational and psychological records and other information
related to my injury, illness or worker’s compensation claim (hereinafter collectively referred to as “Medical Information”) to KBS
Staffing, its employees, agents and authorized representatives. I hereby permit KBS to review and obtain copies of any and all
Medical Information and to discuss pertinent Medical Information with professionals involved in my health care treatment. I
hereby give KBS permission to release the Medical Information to healthcare providers, third party administrators, federal or state
court, Workers’ Compensation Boards, employers, insurers and any other party who may be involved with my claim, treatment or
vocational rehabilitation, or as required by law. Further, pursuant to Title 42 Section 1395y, carriers are required to share
claimants’ Medical Information to enable the Centers for Medicare & Medicaid Services, formerly known as Healthcare Financing
Administration (CMS) to determine eligibility for benefits. I hereby give KBS Staffing Workforce permission to discuss, disclose
and release any Medical Information with or to CMS in connection with my claim. I hereby release KBS Staffing from any liability
or loss due to the release of any Medical Information. I understand that all information released will be handled confidentially and
in accordance with all applicable laws. I also understand that this authorization shall stay in effect until the closure of the claim
file. I certify that this authorization has been made voluntarily and that the information given herein is accurate to the best of my
knowledge. A photocopy of this authorization shall have the same validity as the original.

Accident/Injury Guidelines & Procedures

  1. All injuries must first be reported to your immediate supervisor, who will, then report the incident to KBS Workers’
    Compensation Department before authorization will be given for medical treatment. Exception: emergency situations or if the
    injury occurs after hours and/or on the weekends.
  2. A drug screen is required within 24 hours for all injuries. In accordance with state law, a positive result relieves KBS and its
    insurers from any responsibility for any medical expenses incurred in connection with your injury. Refusal to submit to a drug test
    will result in the same consequences as a positive drug test result. If an employee tests positive on a post-accident drug test,
    they will be discharged for violation of the company substance abuse policy, and workers’ compensation benefits and/or medical
    bills incurred by the employee will be denied.
  3. The employee is required to inform the doctor or medical facility that light duty work is available. The employee will be required
    to work light duty per the doctor’s instructions.
  4. Employees are required to forward all medical information associated with the work-place injury/illness (doctor’s work status
    report, medical records, etc.) within 24 hours of receipt.
  5. Employees are required to complete an Employee Accident/Injury Report within 24 hours of the injury/illness.

Substance Abuse Policy

Any employee on duty or on company property who possesses, sells, receives, or is determined to have measurable levels of
any illegal drug, or sufficient alcohol to impair performance in their blood or urine, will be subject to immediate discharge, and in
appropriate situations, referred to law enforcement authorities. See your Employee Handbook regarding procedures applicable to
prescriptive medications. Periodically, unannounced inspections will be made of persons entering or leaving company work-sites
by authorized company representatives. Entry onto company property is deemed to be consent to an inspection of a person,
locker, vehicle, or any other personal effects. KBS also reserves the right to require employee testing for illegal or controlled
drugs or alcohol, based on reasonable suspicion and I as an employee specifically agree to post- accident drug testing in any
situation where it is allowed by law.

Deductions

By initialing this page below and signing this employment agreement form I authorize deductions when applicable to be made out
of my paycheck for tools, uniforms, health insurance, errors in payroll, garnishments, overpayments, bank fees for stop payment
of a lost or damaged check, and any other work-related deductions. I agree that if I should leave or be discharged from
employment at (the above client company of KBS) before the full amount is paid, any earnings over minimum wage will be
applied to my deduction loan. The amount deducted from my last paycheck may be greater than the amount shown for each
paycheck in accordance with the applicable labor law.


KBS Staffing
480 W. Alluvial Avenue
Fresno, CA. 93650
Phone number: 559-436-6800

Six Hour Meal Period Waiver Agreement

I, hereby agree, by mutual consent of the employer and employee, to waive my required meal period when a work period of not
more than six (6) hours will complete the day’s work, as defined by the State of California Industrial Welfare Commission Order,
Section 11(A).

Acknowledgement of Meal & Rest Periods Policy

This policy details the meal and rest period policy and process for non-exempt employees in California.
Pursuant to California law, employees who work more than five (5) hours will be provided with at least a full thirty (30) minute
meal period. This meal period will begin no later than the fifth hour of work. Additionally, employees who work more than ten (10)
hours in a workday will provided with a second thirty (30) minute meal period. This second meal period must be taken before the
end of the tenth hour of work. Meal periods cannot be taken at the beginning or end of shifts. Employees will be relieved of all of
their duties during meal periods and may not work during this time. An employee’s meal period shall not be considered “on duty”
and will not be counted as time worked.
Employees will be provided ten (10) minute paid rest periods to employees for every four (4) hours worked or major fraction
thereof, unless the employee works less than three and a half hours in a day. Employees will be informed by a supervisor when
to take their rest periods. Whenever practicable, employees should be able to take their rest breaks near the middle of each four-
hour work period. Employees may not accumulate rest periods or use rest periods as a basis for starting work late, leaving their
assigned shift early, or extending a meal period. Because rest breaks are paid, employees should not clock out for them.
This meal and rest break policy applies at all times during your employment, including while placed on job assignment at any
client company in California.
I hereby certify that I fully understand this policy and process regarding meal and rest periods and will comply with
these rules. If I miss or am unable to take a meal or rest period, I agree to notify my local branch office within twenty-
four (24) hours so that my employer can investigate and take the appropriate corrective action.

Harassment, Discrimination and Retaliation Prevention Policy

Reporting Harassment or Discrimination

If you believe that you have been subjected to or witnessed any unlawful harassment, discrimination, or retaliation, you should
immediately report such conduct to your supervisor. If you do not feel comfortable reporting harassment or discrimination to your
supervisor, you should report the harassment and/or discrimination to KBS Human Resources Employee. In addition, if an
employee observes harassment or discrimination by another employee, supervisor, manager, or nonemployee, the employee
should immediately report the incident to the Human Resources Department.
Employees’ notification to KBS is essential to enforcing this policy. Employees may be assured that they will not be penalized in
any way for reporting a harassment or discrimination problem. It is unlawful for employers to retaliate against employees who
oppose practices prohibited by the California Fair Employment and Housing Act (“FEHA”), or who file complaints or otherwise
participate in an investigation, proceeding, or hearing conducted by the California Department of Fair Employment and Housing
(“DFEH”) or the Fair Employment and Housing Commission (“FEHC”). Similarly, KBS prohibits employees form hindering its
internal investigations or its internal complaint procedure.
All complaints of unlawful harassment or discrimination that are reported to management or to the Human Resources
Department will be investigated as promptly as possible through a fair and thorough investigation by an impartial qualified KBS
representative. KBS will conduct its investigation in a manner that provides all parties appropriate due process and reasonable
conclusions that are based on the evidence collected, including by documenting and tracking its investigation. Corrective action
will be taken where warranted and based on the documented evidence.
All complaints of unlawful harassment or discrimination will be treated with as much confidentiality as possible, consistent with
the need to conduct an adequate investigation.
Supervisors and/or managers who witness harassment, discrimination, or retaliation, or who receive reports of harassment,
discrimination, or retaliation, must immediately report such conduct to the Human Resources Department. Failure to do so for
supervisors and/or managers may result in disciplinary action.

Violations of this Policy

Violation of this policy will subject an individual to disciplinary action, up to and including immediate termination. Additionally,
under California law, employees may be held to be personally liable for harassing conduct that violates the FEHA.

Retaliation Prohibited

KBS prohibits retaliation against those who report, oppose or participate in an investigation of alleged violations of this policy.
Participating in an investigation of alleged wrongdoing in the workplace includes:

  1. Filing a complaint with a federal or state enforcement or administrative agency.
  2. Participating in or cooperating with a federal or state enforcement agency that is conducting an investigation of the company
    regarding alleged unlawful activity.

KBS Staffing
480 W. Alluvial Avenue
Fresno, CA. 93650
Phone number: 559-436-6800

Harassment, Discrimination and Retaliation Prevention Policy Cont.

Retaliation Prohibited Cont.

  1. Testifying as a party, witness or accused regarding alleged unlawful activity.
  2. Associating with another employee who is engaged in any of these activities.
  3. Making or filing an internal complaint with the company regarding alleged unlawful activity.
  4. Providing informal notice to the company regarding alleged unlawful activity.KBS strictly prohibits any adverse action or
    retaliation against an employee for participating in an investigation of alleged violation of this policy. If an employee feels that he
    or she is being retaliated against, the employee should immediately KBS Human Resources Employee. In addition, if an
    employee observes retaliation by another employee, supervisor, manager or nonemployee, he or she should immediately report
    the incident to the individuals above.
WORKERS’ COMPENSATION INFORMATION:

This Employment Agreement form is in compliance with labor code LC2810.5
BY SIGNING BELOW, I ACKNOWLEDGE THE RECEIPT OF MY EMPLOYER INFORMATION, MY WAGE INFORMATION, A COPY OF
THIS EMPLOYMENT AGREEMENT, RECEIPT OF THE HARASSMENT, DISCRIMINATION AND RETALIATION PREVENTION POLICY,
AND MY EMPLOYER'S WORKERS COMPENSATION INFORMATION. BY SIGNING BELOW, I ALSO ACCEPT THE TERMS OF THIS
EMPLOYMENT AGREEMENT FORM, ACKNOWLEDGE THAT I UNDERSTAND AND AGREE TO COMPLY WITH THE HARASSMENT,
DISCRIMINATION, AND RETALIATION PREVENTION POLICY, AND CONFIRM THAT ALL MY PERSONAL AND EMPLOYMENT
INFORMATION IS ACCURATE AND CORRECT

California Meal Period and Rest Break Policy
Policy
The Company complies with federal and state legal requirements concerning meal
periods and rest breaks.

The Company recognizes that employees perform at their best when they have the rest
and nourishment they need. This Policy explains when the Company expects
employees to take meal periods and rest breaks.

Meal Periods
The Company provides at least a 30-minute meal period to employees who work more
than five hours, unless they work six or fewer hours total and elect in writing to waive the
first meal period. The Company provides a second 30-minute meal period to employees
who work more than 10 hours in a workday, unless they work twelve or fewer hours
total, did not waive the first meal period, and elect in writing to waive the second meal
period. Employees should take their first meal period before the end of the fifth hour of
work. Employees should take their second meal period before the end of the tenth hour
of work. Meal periods cannot be taken at the beginning or end of shifts. Employees will
be relieved of all of their duties during meal periods and are allowed to leave the store.

The Company provides meal periods according to the following schedule:

Duration of
Shift In Hours
# Meal
Periods
Comments
0 to < 5.0 0 An employee who does not work more than five hours in a workday is not provided with a meal period
> 5.0 to < 10.0 1 An employee who works more than five hours in a
workday, but who does not work more than ten hours in a
workday, is provided with a 30-minute meal period
available before the end of the 5th hour of work, unless the
employee is working six or fewer hours and elects in writing
to waive the first meal period.
> 10.0 2 An employee who works more than ten hours in a workday
is provided with a second 30-minute meal period available
before the end of the 10th hour of work, unless the
employee is working twelve or fewer hours, did not waive
the first meal period, and elects in writing to waive the
second meal period.

The Company does not pay non-exempt employees for meal periods, and consequently,
non-exempt employees must record the start and stop times of their meal periods.

Any non-exempt employee who is required to work through some or all of a 30-minute
meal period, or who is required to take a late meal period (i.e., is required to begin the
first meal period after the end of the fifth hour of work or is required to begin a second
mea period after the end of the tenth hour of work), should complete a California Meal
Period and Rest Break Premium Request Form and submit it to his/her manager by no
later than the end of the pay period. Otherwise, the Company will assume that any non-
exempt employee who fails to record a meal period, records a less-than-30-minute meal
period, or takes and records a late meal period, did so voluntarily.

Rest Breaks
Non-exempt employees are authorized and permitted to take a 10-minute paid rest
break for every four hours worked, or major fraction thereof. The Company authorizes
and permits rest breaks according to the following schedule:

Duration of Shift
In Hours
# of 10 Minute Rest
Breaks
Comments
0 to < 3.5 0 A non-exempt employee who does not work more than
3.5 hours in a workday is not authorized and permitted
to take a rest break.
> 3.5 to < 6 1 A non-exempt employee who works more than 3.5
hours in a workday but who does not work more than 6
hours in a workday is authorized and permitted to take
one 10-minute rest break.
> 6.0 to < 10.0 2 A non-exempt employee who works more than 6 hours
in a workday but who does not work more than 10
hours in a workday is authorized and permitted to take
two 10-minute rest breaks.
> 10.0 to < 14.0 3 A non-exempt employee who works more than 10
hours in a workday but who does not work more than
14 hours in a workday is authorized and permitted to
take three 10-minute rest breaks.

Whenever practicable, non-exempt employees should take their rest breaks near the
middle of each four-hour work period. Non-exempt employees may not accumulate rest
breaks or use rest breaks as a basis for starting work late, leaving work early, or
extending a meal period.

Non-exempt employees who work more than 14 hours in a workday may be entitled to
additional rest breaks.

Because rest breaks are paid, non-exempt employees should not clock out for them.

Any non-exempt employee who is not authorized and permitted to take a rest break
pursuant to the terms of this Policy should complete a California Meal Period and Rest
Break Premium Request Form and submit it to his/her manager by the end of the pay
period. Otherwise, the Company will assume the employee either took his/her rest
break or voluntarily decided to waive it.

Responsibilities
Non-exempt employees are expected to take their meal periods and rest breaks in
accordance with the applicable guidelines set forth in this Policy. Management is
expected to make meal periods and rest breaks available to their employees in
accordance with this Policy. Supervisors can schedule meal periods and rest breaks for
their employees, taking into account their department’s operational requirements and
employee needs. Supervisors may stagger employees’ meal periods so ongoing
operational responsibilities are not compromised, so long as the applicable guidelines in
this Policy are met.

Supervisors are responsible for administering their department’s meal and rest breaks in
a fair and uniform manner. Supervisors may not pressure or coerce employees to skip
their meal periods or rest breaks.

Discipline
Any employee, supervisor, or manager who fails to observe meal period and rest break
policies will be subject to discipline, up to and including termination of employment.
Violations of this Policy should be reported to any manager or the Human Resources
Department. Every report will be fully investigated and corrective action will be taken
where appropriate.

In addition, the Company will not allow any form of retaliation against individuals who
report alleged violations of this Policy or who cooperate in the Company’s investigation
of such reports. Any form of retaliation in violation of this Policy will result in disciplinary
action, up to and including termination.

Acknowledgment Of Receipt Of
California Meal Period And Rest Break Policy

I acknowledge that I have been provided with and understand the Company’s California
Meal Period and Rest Break Policy, and understand that it is effective immediately. I
agree to comply with this Policy.

I acknowledge, understand, and agree that I must notify my supervisor immediately if I
am required to work through some or all of a timely 30-minute meal period or a 10-
minute rest break, , and that I should complete a premium form and submit it to my
manager to ensure that I am properly compensated.

I understand that I may be subject to disciplinary action, up to and including termination
of employment, if I violate this Policy.

EMPLOYERS OUTSOURCING INC.

Smiley face

AUTHORIZATION FOR AUTOMATIC PAYROLL DEPOSIT.

Company:

I authorize my employer to deposit my wages/salary into the bank accounts specified below. I agree that
direct deposit transactions I authorize comply with all applicable law. My signature below indicates that I am
agreeing that I am either the accountholder or have the authority to authorize my employer to make direct
deposits into the named account. This form along with proper documentation MUST be complete in order to
process.

Be aware that your direct deposit can take up to 4 weeks to activate after the date of receipt.

Banking information::

REQUIRED: PLEASE PLACE YOUR CANCELLED CHECK WITH YOUR
PRINTED NAME ON IT HERE.
IF YOU DO NOT HAVE CHECKS FOR THIS ACCOUNT, PLEASE ATTACH A
COPY OF ANY ONE OF THE ACCEPTABLE DOCUMENTS LISTED ABOVE.

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11208 Whittier Blvd.
Whittier, California.
90606