Please list two professional references
Employment Eligiblity Verification
Department of Homeland Security
U.S. Citizenship and Immegration Services
“OMB No: 1615-0047, Expires 10/31/2022”
Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form.
It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination
Employee Information and Attestation (Employees must complete and sign Section 1 of Form 1-9 no later than the first day of employment, but not before accepting a job offer.)
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):
Aliens authorized to work must provide only one of the following document numbers to complete Form 1-9: An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign Passport Number.
Preparer and/or Translator Certification (check one):
Form W-4 Department of the treasury.
internal Revenue Service
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
Give Form W-4 to your employer.
Your withholding is subject to review by the IRS.
Enter Personal Information
Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.
See page 2 for more informtion on each step who can claim exemption from withholding when to use the estimater at http://www.irs.gov/W4App
, and Privacy.
Steps 2: Multiple Jobs or Suppose Work
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse Multiple Jobs
also works. The correct amount of withholding depends on income earned from all of these jobs
Do only one of the following.
(a) Use the estimator at lwww.irs.gov/W4App
for most accurate withholding for this step (and Steps 3-4); or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate
TIP: To be accurate, submit a 2022 Form W-4 for all other jobs. If you (or your spouse) have self-employment
income, including as an independent contractor, use the estimator.
Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3: Claim Dependents *
If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Step 4 (optional): Other Adjustments
Step 5: Sign Here *
(This form is unvalid unless you sign it.)
Upload photos of your ID/SSN Card (front and back)
Accepted file types: jpg, png, Max. file size: 2 GB.
Drop files here or
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Cat. No. 10220Q
Form W-4 (2022)
DEPARTMENT OF REVENUE 2022 W-4MN, Minnesota Withholding Allowance/Exemption Certificate Employees
Complete Form W-4MN so that your employer can withhold the correct Minnesota income tax from your pay. Consider completing a new Form W-4MN each year and when your personal or financial situation changes
Complete Section 1 or Section 2, then sign the bottom (Required)
• You are single and have only one job
• You are married, have only one job, and your spouse does not work
• Your wages from a second job or your spouse’s wages are $1500 or less C Enter “1” if you are married. Or choose to enter “0” if you are married and have either a working
• I had no Minnesota income tax liability last year
• I received a refund of all Minnesota income tax withheld
• I expect to have no Minnesota income tax liability this year
• My spouse is a military service member assigned to a military location in Minnesota
. My domicile (legal residence) is in another state.
Upload your Resume (Recommended – Some Jobs Require)
BACKGROUND CHECK AUTHORIZATION
I hereby authorized Restaffing and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justices agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorize any individual, company, firm, corporations, or public agency to divulge any and all information, verbal or written, pertaining to me, to Restaffing or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. Restaffing and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and date of birth.
I further authorize any individual, company, firm, corporations, or public agency to divulge any and all information, verbal or written, pertaining to me, to Restaffing or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. Restaffing and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and date of birth.
INCIDENT/ACCIDENT & ZERO DRUG TOLERATE POLICY
SAFETY: To prevent/reduce work related injuries employees are required by law to fully comply with employer’s safety guidelines. Employee(s) must fully follow employer’s directions in the use of necessary tools, equipment and/or wear any safety gearas directed.
Employees must follow employer’s safety rules as specified at each work site, which could include but are not limited to verbal, written instructions, signs, any handout materials or self awareness.
Any work related injuries are required by law to be reported to the on-site line lead, supervisor and/or manager in writing immediately or by phone if working remotely.
In the event of employee injured. Employee is referred to be treated at Minnesota Occupational Health located at 1661 St Anthony Ave #2, St Paul, MN 55104 Phone number (651) 968 – 5300 or if emergency-be treated at the nearest healthcare provider.
Restaffing LLC reserves the right to forward any suspicious claims to the worker’s compensation insurance company to further investigate for potential fraud. Any fraud found can and may lead to prosecution as a punishable crime.
PRE-SCREENING FEE MAY APPLY
RESTAFFING LLC, is required that all applicants must completed employment verification and background check prior to start working. The applicant must understand that there will be $80 deducted from pay check for employee who failed to meet the 3 days minimum working at RESTAFFING LLC. This include not limited to the employee’s voluntarily to quit or dismissal by RESTAFFING LLC due poor attendance, performance or fail to meet their job specification. The fee will be waived after employee is successfully completed 3 full days of employment with RESTAFFING LLC.
By signing this agreement the applicants has agreed and fully understand the above terms and conditions.