Mandatory Contact Notice
*) I understand and agree that, upon conclusion of each assignment and upon the resignation of my assignment, I must immediately contact by telephone my Company Representative between the hours of 9AM and 5PM. I understand that such notification is for the purpose of determining eligibility and availability of additional work assignments as well as other administrative purposes. If my Company Representative is not available, I will ask to speak with the Branch Manager or On-Site Manager. I accept that:
a) My failure to contact my Company Representative by phone within two business days* of completion of assignment or my resignation of assignment may result in a voluntary quit and or the denial and/or interruption of unemployment benefits.
b) If a suitable assignment is available upon conclusion of my assignment and I fail to inquire about another assignment before filing for unemployment benefits, it may lead to an interruption and/or denial of unemployment benefits. c) If a suitable assignment is available upon conclusion of my assignment and I refuse an offer of suitable work, it may lead to an interruption and/or denial of unemployment benefits. d) The Company is not obligated to find me another assignment once I complete an assignment. If Company has an open position, I should contact the local branch or apply for the position online. e) I will contact my Company Representative at least once per week when I am not on assignment to verify my availability to work.
f) By providing my phone number to the Company, I expressly consent to receive phone calls and/or text messages from the Company and its affiliates regarding job opportunities and employment. 2) I also understand and agree that I am required to contact my Company Representative: a) When my address, email, or phone number changes. b) If I experience any type of harassment or unlawful discrimination. c) If I am not being provided a meal or rest break to which I am entitled. d) If I have a complaint or dispute about my wages earned. e) If I am injured while on assignment.
I certify that I have read, fully understand, and accept all terms of the foregoing agreement: Employee Name Employee Signature
* Exceptions to the two-business day notification period are listed below:
• Michigan – Associates must contact the company representative within seven working days of completion of the temporary assignment.
• Minnesota – Please request a copy of the MN Unemployment Insurance Notice
• Iowa – Associates must contact the company representative within three working days of completion of the temporary assignment.
• Oklahoma – Associates will be deemed to have left his or her last work voluntarily without good cause connected with the work if the temporary employee does not contact the temporary help firm for reassignment on completion of an assignment. If you have any questions, please contact your Company Representative or consult your Employee Handbook. To locate your local Company Representative, please go to https://www.adeccousa.com/locations/ Version: Adecco General Staffing 12/2020
KIMBERLY R BELL KIMBERLY R BELL (e-sign I agree)
AUTHORIZATION FOR BACKGROUND INVESTIGATION
AND USE OF INFORMATION FOR EMPLOYMENT
(“AUTHORIZATION”)
I have read and understood the stand-alone consumer disclosure(s) that the Company has separately provided to me regarding consumer reports and/or investigative consumer reports (collectively,
“Reports”).
I authorize the Company and/or its Client(s) to obtain Reports for employment purposes from consumer reporting agencies at any time after I sign this Authorization. To the extent permitted by law, I also consent to the Company obtaining additional Reports from a consumer reporting agency for an employment purpose at any time during my employment. To this end, I authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, insurance company, employer, neighbor, friend, associate, or others with whom I am acquainted or who may have pertinent knowledge, to furnish any and all background information requested. I further authorize the following information to be provided for employment purposes to the Company, its Client(s), any consumer reporting agency, and their respective officers, agents or employees to the extent permitted by law:
1. Consumer Reports and/or Investigative Consumer Reports; 2. Personally identifiable information, including but not limited to driver’s license and Social Security numbers;
3. Information regarding my authorization to work in the United States; and 4. Insurance enrollment information.
I hereby authorize the Company to transmit this information electronically or otherwise where permitted by law.
Signature Line follows the State-Specific Disclosures STATE-SPECIFIC DISCLOSURES
California Residents: Please review and sign the separately provided “Disclosure of Intent to Obtain a California Investigative Consumer Report” and “Authorization and Consent to Obtain Investigative Consumer Report For Employment Purposes” forms. Minnesota and Oklahoma Residents: Under Minnesota and Oklahoma law, you have a right to receive a free copy of your Report by checking the appropriate box below.
YES, I am a Minnesota resident and would like a free copy of my consumer report.
YES, I am an Oklahoma resident and would like a free copy of my consumer report. Minnesota: You may request a complete and accurate disclosure of the nature of any Report obtained by the Company.
Massachusetts and New Jersey: You have the right to request an investigative consumer report from a consumer reporting agency. If one has been requested, the specific nature and scope of the Report requested will be to confirm and verify information provided to the Company during your application and onboarding process and other background information about you, including but not limited to obtaining a criminal record report, verifying references, confirming education information, work history, your social security number, your educational achievements, licensure, and certifications, your driving record, and other information about you, and interviewing people who are knowledgeable about you.
New York State: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency directly. By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law.
Washington State Notice: You also have the right to request a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. I have read and accept the terms of this Authorization. I acknowledge that a hard or digital copy of this authorization shall be as valid as the original. Last Name: First Middle
Signature: Date:
KIMBERLY R BELL (e-sign I agree) 11/11/2022
BELL KIMBERLY