OFFICE USE ONLY Unit Size Requested Unit Number Targeted Move-In Date Date Received Time Received _N__o__b__le__s__S__q__u_a__q__r_e__A__p__a_r_t_m___e_n__t_s____________ _2__1_7__5__N___o_b__l_e_s___S_t_r_e__e__t_______________________ _W___o__r_th__i_n_g__t_o_n__,__M__N___5__6_1__8__7__________________ _(_5__0_7__)__3_6__0__-_6_0__8__3_____________________________ APPLICATION FOR OCCUPANCY Incomplete applications will be returned APPLICANT INFORMATION Applicant Name (Head of Household): First Middle Last Address: Street Address City State Zip Social Security Number: Date of Birth: [ ] Male [ ] Female [ ] Decline Applicant Phone #: Applicant Email: Alternate Phone #: Alternate Email: Emergency Contact: Name (Someone outside your household) Phone Email List All Other Household Members First MI Last Relationship to Head Date of Birth Male/Female/ Decline to Answer Social Security Number [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline Primary Language: Do you require an interpreter? [ ] Yes [ ] No How did you hear about this housing? [ ] Online [ ] Newspaper [ ] Local Agency [ ] Drive By [ ] Resident Referral [ ] Other What is the combined gross monthly income of all household members? $ ADDITIONAL HOUSEHOLD MEMBERS CURRENT HOUSING STATUS How long have you lived at your current address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: Do all adult household members live at this address?........................................................................................................................ [ ] Yes [ ] No If NO, include additional adult household’s current address and contact information on a separate piece of paper. PREVIOUS HOUSING STATUS Your previous address: How long did you live at your previous address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: List every state in which each household member has lived: ELIGIBILITY INFORMATION The following questions pertain to yourself and every member of your household who will occupy the unit. Check either Yes or No in response to each question. All questions must be answered; for those questions that do not apply, you are required to indicate so by answering “not applicable” or “n/a”.
Employee Only 31.2 For medically single employees (Employee Only) who enroll in any health plan offered through the Health Services System, the City shall contribute ninety-three percent (93%) of the total health insurance premium, provided however, that the City’s contribution shall be capped at ninety-three percent (93%) of the Employee Only premium of the second-highest-cost plan. Employee Plus One:
Part-Time Only A rest period of fifteen (15) minutes will be granted during each half tour provided the duration of each half tour is not less than three (3) hours.
For Office Use Only Ref No ) Print Name …………………………………………….......... Customer No……………………………..................... Representing………………………………….…………....... Transferor Signature……………………………......... Position in organisation: Representing Hull City Council Owner Partner Other …………......................... Date................................................................................... Date …………………………….................................. Please complete sections A, B, C & sign section F and return this form to Trade Waste Team, Hull City Council, Staveley House, Stockholm Road, HULL HU7 0XW marked F.A.O. Commercial Waste Officer. A copy will be returned to you by email or post for your records after verification. It is a legal requirement to keep this transfer note for at least 2 years after the final collection. P.T.O.
Full-Time Only During the year of the leave, seniority shall continue to accumulate. Service for the purposes of vacation and salary progression and other benefits will be retained but will not accumulate during the period of the leave.
Official Use Only No Personal Use The Contract is only for official use by Authorized Users. Use of the Contract for personal or private purposes is strictly prohibited.
General Xxxxxxx 9B.01 When a general xxxxxxx is appointed by the employer and/or as required by the collective agreement, they will be paid a minimum premium of fifteen percent (15%) of base rate and holiday and vacation allowance.
JOB XXXXXXX (a) There shall be a Xxxxxxx on each job at all times, who shall be a Union Member in good standing, and shall be appointed by the Business Representative, from amongst the Employees on the job. The Union shall notify the Employer, in writing, who their Xxxxxxx is. If the Employer disapproves of the said appointed Xxxxxxx, they shall immediately notify the Union, in writing, stating the reasons for their disapproval. If their reasons are acceptable to the Union, a new Xxxxxxx will be appointed immediately. If not acceptable, the Union and the Employer will meet to discuss the reasons for disapproval, and if necessary, grievance procedure will be followed. The Xxxxxxx shall keep a record of members hired, laid-off, and discharged, and shall take up all grievances on the job, and try to have same adjusted. In the event he/she cannot adjust them, he/she must promptly report that fact to the Business Representatives of the Union, so STEP 2 of the Grievance Procedure can be followed through. He/She shall see that the provisions of this Agreement are complied with and report the true conditions and facts. It is recognized as the Employer’s responsibility to make whatever provisions are necessary for the care of injured worker. It shall be the duty of the Xxxxxxx to see that the Employer fulfils its obligation. The Employer agrees that when Employees are laid-off, all things being equal, the Xxxxxxx will be one of the last employees laid-off. The Employer further agrees that the Xxxxxxx will not be transferred to another jobsite unless mutually agreed by the Employer Representative and the Union Representative. The Union agrees that the Xxxxxxx shall not be changed without prior notification to the Employer.
Copayments Effective January 1, 2019, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist. Service In-Network Out-of-Network Diagnostic/Preventive 100% 50% after deductible Fillings 80% after deductible 50% after deductible Endodontics 80% after deductible 50% after deductible Periodontics 80% after deductible 50% after deductible Oral Surgery 80% after deductible 50% after deductible Crowns 80% after deductible 50% after deductible Implants Prosthetics 80% after deductible 80% after deductible 50% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics 80% after deductible 50% after deductible
Copayment A fixed amount You pay directly to a Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Cost-Sharing: Amounts You must pay for Covered Services, expressed as Copayments, Deductibles and/or Coinsurance. Cover, Covered or Covered Services: The Medically Necessary services paid for, arranged, or authorized for You by Us under the terms and conditions of this Contract. Deductible: The amount You owe before We begin to pay for Covered Services. The Deductible applies before any Copayments or Coinsurance are applied. The Deductible may not apply to all Covered Services. You may also have a Deductible that applies to a specific Covered Service that You owe before We begin to pay for a particular Covered Service. Dependents: The Subscriber’s Spouse and Children. Emergency Dental Care: Emergency dental treatment required to alleviate pain and suffering caused by dental disease or trauma. Refer to the Pediatric Dental Care and Adult Dental Care sections of this Contract for details.
